Provider Demographics
NPI:1902630072
Name:RODRIQUEZ, DAVID LEE (LPN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:RODRIQUEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-5152
Mailing Address - Country:US
Mailing Address - Phone:806-853-4984
Mailing Address - Fax:
Practice Address - Street 1:100 NM HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052-1249
Practice Address - Country:US
Practice Address - Phone:505-404-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPN-21817164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse