Basic Information
| Provider Information | |||||||||
| NPI: | 1619221736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | VANESSA | ||||||||
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| Credential: | IOMT,CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S ALBION ST | ||||||||
| Address2: | SUITE 425 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202142549 | ||||||||
| FaxNumber: | 3037447876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S ALBION ST | ||||||||
| Address2: | STE. 130 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202142549 | ||||||||
| FaxNumber: | 3037447876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2012 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.