Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 99992 | CO |
NPI | 1700897576 |
---|---|
Provider Name | M David Rodriguez |
First Address | Denver, CO 80247-1130 |
Second Address | Denver, CO 80247-1130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23605553 | (05) | CO |
CO300023 | (02) | CO |
P58283 | (02) | CO |