MEDICARE: EDMEE RODRIGUEZ M.D.

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
1	207R00000X	Internal Medicine Physician	MD2004-0764	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346260544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMEE RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	4105 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1102
Country	:	US
Telephone Number	:	505-737-9411
Fax Number	:	505-884-6845

Provider Business Practice Location Address
First Line	:	4105 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1102
Country	:	US
Telephone Number	:	505-737-9411
Fax Number	:	505-884-6845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/20/2024

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