Healthcare Provider Details

I. General information

NPI: 1225460132
Provider Name (Legal Business Name): JOSE ANTONIO RODRIGUEZ ARCINIEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 07/22/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MALL DR
LAS CRUCES NM
88011-8128
US

IV. Provider business mailing address

1160 MALL DR
LAS CRUCES NM
88011-8128
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3000
  • Fax:
Mailing address:
  • Phone: 203-360-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2021-0487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: