Provider Demographics
NPI:1295962702
Name:RODRIGUEZ, LAURA (CASE MANAGER)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KIKER PLACE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415
Mailing Address - Country:US
Mailing Address - Phone:505-280-2275
Mailing Address - Fax:
Practice Address - Street 1:103 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-3049
Practice Address - Country:US
Practice Address - Phone:575-374-2032
Practice Address - Fax:575-374-0158
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist