Provider Demographics
NPI:1124127139
Name:MERINO, RODRIGO R (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:R
Last Name:MERINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:
Other - Last Name:MERINO-ROLDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:933 BRADBURY DR SE
Practice Address - Street 2:SUITE 2222
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4374
Practice Address - Country:US
Practice Address - Phone:505-272-3120
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31587-0202084N0400X
IL360551292084N0400X
NMMD2015-04182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124127139Medicaid
C45346Medicare UPIN
C45346Medicare UPIN