Healthcare Provider Details

I. General information

NPI: 1124368055
Provider Name (Legal Business Name): CESAR B RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 200
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-2300
  • Fax: 505-839-2303
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0055
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: