Rodolfo Cesar Pena, PHD – Pharmacist

Key facts

NPI: 1205017100
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: RP00006520 (NM)
Practice address: 500 Walter St NE
Suite 301
Albuquerque, NM 87102-2534
Phone: (505) 262-3851
Fax: (505) 262-7040
NPI assigned: Nov 19, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Optumcare New Mexico LLC Family Medicine Physician · Albuquerque, NM · NPI 1124053210

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
RP00006520	NM	MD	Pharmacotherapy Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Optumcare New Mexico LLC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	RP00006520	NM	Yes
Pharmacotherapy Pharmacist	1835P1200X	RP00006520	NM

Addresses

Primary practice location

500 Walter St NE
Suite 301
Albuquerque, NM 87102-2534

Mailing address

500 Walter St NE
Suite 301
Albuquerque, NM 87102-2534
Phone (505) 262-3851

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2007.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195430400000",
    "number": "1205017100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 WALTER ST NE",
            "address_2": "SUITE 301",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022534",
            "telephone_number": "505-262-3851",
            "fax_number": "505-262-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 WALTER ST NE",
            "address_2": "SUITE 301",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022534",
            "telephone_number": "505-262-3851",
            "fax_number": "505-262-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "RODOLFO",
        "middle_name": "CESAR",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "RP00006520",
            "primary": true
        },
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "NM",
            "license": "RP00006520",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

All providers in Albuquerque, NM · Pharmacist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.