Provider Demographics
NPI:1336608298
Name:RODRIGUEZ, BRIANNA K (BPH)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1278
Mailing Address - Country:US
Mailing Address - Phone:575-522-5144
Mailing Address - Fax:
Practice Address - Street 1:250 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1278
Practice Address - Country:US
Practice Address - Phone:575-522-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator