Provider Demographics
NPI:1174919237
Name:RODRIGUEZ GRAZIOSO, RODRIGO ANDRES (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:ANDRES
Last Name:RODRIGUEZ GRAZIOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3131 LA CANADA ST STE 217
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3131 LA CANADA ST STE 217
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2579
Practice Address - Country:US
Practice Address - Phone:702-369-7152
Practice Address - Fax:702-369-7153
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63088208600000X, 2086S0127X
NMRS2015-0337390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program