Provider Demographics
NPI:1194367862
Name:PEREZ-RESENDIZ, RODRIGO (PA-C)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:PEREZ-RESENDIZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SANDOVAL RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7320
Mailing Address - Country:US
Mailing Address - Phone:505-865-3373
Mailing Address - Fax:
Practice Address - Street 1:145 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8841
Practice Address - Country:US
Practice Address - Phone:505-865-4618
Practice Address - Fax:505-224-8727
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1194827535207Q00000X
NMPA2019-0088363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine