Provider Demographics
NPI:1427833763
Name:RODRIQUEZ, TOMAS ELLIS
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:ELLIS
Last Name:RODRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 OAK ST APT 104
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-5829
Mailing Address - Country:US
Mailing Address - Phone:720-470-3632
Mailing Address - Fax:
Practice Address - Street 1:6380 OAK ST APT 104
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5829
Practice Address - Country:US
Practice Address - Phone:720-470-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional