Healthcare Provider Details

I. General information

NPI: 1568451839
Provider Name (Legal Business Name): MONICA C RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD # 404
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-2748
  • Fax: 602-406-2770
Mailing address:
  • Phone: 602-406-2748
  • Fax: 602-406-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberE4402
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number47578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: