Healthcare Provider Details

I. General information

NPI: 1811973191
Provider Name (Legal Business Name): RODAMES D DEDICATORIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28516 N EL MIRAGE RD STE 105
PEORIA AZ
85383-2094
US

IV. Provider business mailing address

PO BOX 24981
BELFAST ME
04915-2000
US

V. Phone/Fax

Practice location:
  • Phone: 480-716-4928
  • Fax: 623-401-9306
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80156
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: