MEDICARE: SUZANNE ROSE RODRIGUEZ CPT

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	171400000X	Health & Wellness Coach	1210728861	AZ

General Provider Information

NPI Number	:	1639943699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE ROSE RODRIGUEZ CPT

Provider Business Mailing Address
First Line	:	3040 RIO BRAVO BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-5532
Country	:	US
Telephone Number	:	505-917-3963
Fax Number	:	505-314-5443

Provider Business Practice Location Address
First Line	:	3040 RIO BRAVO BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-5532
Country	:	US
Telephone Number	:	505-917-3963
Fax Number	:	505-314-5443

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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