Healthcare Provider Details

I. General information

NPI: 1346657459
Provider Name (Legal Business Name): ALEX RYAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 28 3/4 RD BLDG A
GRAND JUNCTION CO
81501-5016
US

IV. Provider business mailing address

PO BOX 3807
GRAND JUNCTION CO
81502-3807
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-6023
  • Fax: 970-243-8631
Mailing address:
  • Phone: 970-683-7131
  • Fax: 970-243-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0019532
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: