Healthcare Provider Details

I. General information

NPI: 1669749552
Provider Name (Legal Business Name): ANGELICA MARIA RODRIGUEZ AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELICA MARIA GONZALEZ AU.D.

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W 4TH ST
ROSWELL NM
88201-3038
US

IV. Provider business mailing address

1000 W 4TH ST
ROSWELL NM
88201-3038
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-8474
  • Fax: 575-623-8220
Mailing address:
  • Phone: 575-623-8474
  • Fax: 575-623-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4960
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: