Healthcare Provider Details

I. General information

NPI: 1093210817
Provider Name (Legal Business Name): AXEL G RODRIGUEZ ROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 E MARKET ST STE 2
WARREN OH
44484-2324
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-5090
  • Fax: 330-965-5099
Mailing address:
  • Phone: 330-965-5090
  • Fax: 330-965-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.146644CTR
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35.146644CTR
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: