| Denise Rodriguez, Llc | |
|
2885 N Brookbury Xing Fayetteville AR 72703-4377 | |
| (479) 466-8986 | |
| Not Available |
| Full Name | Denise Rodriguez, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2885 N Brookbury Xing, Fayetteville, Arkansas |
| Authorized Official Name and Position | Denise C Rodriguez (OWNER) |
| Authorized Official Contact | 4794668986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Denise Rodriguez, Llc 2885 N Brookbury Xing Fayetteville AR 72703-4377 Ph: (479) 466-8986 | Denise Rodriguez, Llc 2885 N Brookbury Xing Fayetteville AR 72703-4377 Ph: (479) 466-8986 |
| NPI Number | 1679212476 |
|---|---|
| Provider Enumeration Date | 05/31/2022 |
| Last Update Date | 01/02/2023 |
| Certification Date | 12/27/2022 |
| Medicare PECOS PAC ID | 9032582655 |
|---|---|
| Medicare Enrollment ID | O20230302000290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679212476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Denise Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730716887 PECOS PAC ID: 9133540545 Enrollment ID: I20200610001249 |
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