Healthcare Provider Details

I. General information

NPI: 1801272034
Provider Name (Legal Business Name): MS. DENISE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 LEETSDALE DR STE 220
DENVER CO
80246-1438
US

IV. Provider business mailing address

5250 LEETSDALE DR STE 220
DENVER CO
80246-1438
US

V. Phone/Fax

Practice location:
  • Phone: 303-629-5293
  • Fax: 303-322-0365
Mailing address:
  • Phone: 303-629-5293
  • Fax: 303-322-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: