Healthcare Provider Details

I. General information

NPI: 1144149634
Provider Name (Legal Business Name): SAMANTHA JO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA JO VARNEY

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 HILTON AVE NE
ALBUQUERQUE NM
87110-1095
US

IV. Provider business mailing address

4321 HILTON AVE NE
ALBUQUERQUE NM
87110-1095
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-2473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: