Provider Demographics
NPI:1306258116
Name:CID, RODRIGO MARAMBA (ANP)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:MARAMBA
Last Name:CID
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HANCOCK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5948
Mailing Address - Country:US
Mailing Address - Phone:928-758-0121
Mailing Address - Fax:928-758-0128
Practice Address - Street 1:1225 HANCOCK RD
Practice Address - Street 2:SUITE C
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5948
Practice Address - Country:US
Practice Address - Phone:928-758-0121
Practice Address - Fax:928-758-0128
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5504364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health