Healthcare Provider Details

I. General information

NPI: 1861279192
Provider Name (Legal Business Name): COURTNEY MOORE RODRIGUEZ CPD, CLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 S PENNSYLVANIA ST
CENTENNIAL CO
80122-1152
US

IV. Provider business mailing address

7110 S PENNSYLVANIA ST
CENTENNIAL CO
80122-1152
US

V. Phone/Fax

Practice location:
  • Phone: 303-868-9671
  • Fax:
Mailing address:
  • Phone: 303-868-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: