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NPI Code Detail

MEDICARE: MR. NICK BALARAMA RODRIGUEZ AA

MEDICARE: MR. NICK BALARAMA RODRIGUEZ AA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367H00000XAnesthesiologist AssistantPENDINGMO
2367H00000XAnesthesiologist AssistantAA2024-0006NM

General Provider Information

NPI Number : 1043997190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICK BALARAMA RODRIGUEZ AA
Provider Business Mailing Address
First Line : 800 BRADBURY DR SE STE 116
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-4310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 S NEW BALLAS RD DEPT OF
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8221
Country : US
Telephone Number : 636-386-9224
Fax Number : 636-386-7679
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2023
Last Update Date : 03/04/2026

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