Healthcare Provider Details

I. General information

NPI: 1306258116
Provider Name (Legal Business Name): RODRIGO MARAMBA CID A.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 HANCOCK RD SUITE C
BULLHEAD CITY AZ
86442-5948
US

IV. Provider business mailing address

1225 HANCOCK RD SUITE C
BULLHEAD CITY AZ
86442-5948
US

V. Phone/Fax

Practice location:
  • Phone: 928-758-0121
  • Fax: 928-758-0128
Mailing address:
  • Phone: 928-758-0121
  • Fax: 928-758-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP5504
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: