Healthcare Provider Details

I. General information

NPI: 1700439882
Provider Name (Legal Business Name): DEBORAH SUE RODRIGUEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 COORS BLVD NW STE E
ALBUQUERQUE NM
87120-1926
US

IV. Provider business mailing address

1012 EL PASEO ST NW
RIO RANCHO NM
87144-1410
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-6560
  • Fax: 505-715-5537
Mailing address:
  • Phone: 925-413-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7866
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: