Basic Information
| Provider Information | |||||||||
| NPI: | 1346657459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 HORIZON DR | ||||||||
| Address2: | STE 225 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815068700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706837107 | ||||||||
| FaxNumber: | 9706837167 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 OURAY AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702416099 | ||||||||
| FaxNumber: | 9702410797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2014 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.