Healthcare Provider Details

I. General information

NPI: 1780428961
Provider Name (Legal Business Name): REDEEMED HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 154
GLENDALE AZ
85308-4622
US

IV. Provider business mailing address

5115 N DYSART RD STE 202 #183
LITCHFIELD PARL AZ
85340
US

V. Phone/Fax

Practice location:
  • Phone: 623-363-5480
  • Fax:
Mailing address:
  • Phone: 623-363-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL RODRIGUEZ
Title or Position: PRESIDENT
Credential: DO
Phone: 623-363-5480