{
"Npi": {
"NPI": "1326301474",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RODRIGUEZ",
"FirstName": "MANUEL",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": "IV",
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1338 PHAY AVE BLDG D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANON CITY",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81212-2326",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1338 PHAY AVE BLDG D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CANON CITY",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81212-2326",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-285-2735",
"PracticeLocationAddressFaxNumber": "719-285-2915",
"EnumerationDate": "06/22/2012",
"LastUpdateDate": "09/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "DR.0072273",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "02004519A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}