Healthcare Provider Details

I. General information

NPI: 1528029980
Provider Name (Legal Business Name): LEONEL G. RODARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 FOOTHILLS RD SUITE B
LAS CRUCES NM
88011-4672
US

IV. Provider business mailing address

3885 FOOTHILLS RD SUITE B
LAS CRUCES NM
88011-4672
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5111
  • Fax: 575-522-5115
Mailing address:
  • Phone: 575-522-5111
  • Fax: 575-522-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNM2002-0380
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: