Healthcare Provider Details

I. General information

NPI: 1811097538
Provider Name (Legal Business Name): RAUL J RODRIGUEZ-SORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 04/25/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 S COTTONWOOD DR
TEMPE AZ
85282-3040
US

IV. Provider business mailing address

3930 N 30TH AVE
PHOENIX AZ
85017-4607
US

V. Phone/Fax

Practice location:
  • Phone: 480-718-0568
  • Fax: 520-290-4881
Mailing address:
  • Phone: 623-322-6143
  • Fax: 520-290-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number21047
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: