Healthcare Provider Details

I. General information

NPI: 1164387403
Provider Name (Legal Business Name): NAOMI RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10190 BANNOCK ST STE 120
NORTHGLENN CO
80260-6052
US

IV. Provider business mailing address

2600 S ROCK CREEK PKWY APT 13-203
SUPERIOR CO
80027-4563
US

V. Phone/Fax

Practice location:
  • Phone: 720-248-9363
  • Fax:
Mailing address:
  • Phone: 720-417-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: