Provider Demographics
NPI:1982752093
Name:RODRIGUEZ, CONRADO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15822 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2651
Mailing Address - Country:US
Mailing Address - Phone:402-212-4409
Mailing Address - Fax:402-339-4709
Practice Address - Street 1:1311 S 9TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-3629
Practice Address - Country:US
Practice Address - Phone:402-210-9393
Practice Address - Fax:402-339-4709
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE616103T00000X
FLPY6741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE249021OtherMIDLANDS CHOICE
NE10025231300Medicaid
NE80012OtherBLUE CROSS BLUE SHIELD
FLU1349ZMedicare UPIN
NE10025231300Medicaid
NEP98244Medicare UPIN
NE278780Medicare ID - Type UnspecifiedMEDICARE PROVIDER # IN NE