Active NPI
Paul Rodriguez, LPN
- Licensed Practical Nurse
- Las Cruces, NM
National Provider Identifier
1467950840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L16882
- Practice address
- 105 W Griggs Ave
Las Cruces, NM 88001-1235 - Phone
- (575) 647-2800
- Fax
- (575) 647-2898
- NPI assigned
- Jan 31, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L16882 | NM | Primary |
Addresses
Primary practice location
105 W Griggs Ave
Las Cruces, NM 88001-1235
Mailing address
385 Calle de Alegra Ste a
Las Cruces, NM 88005-3423
Phone (575) 526-1105
Other practice location 1
826 Anthony Dr.
Anthony, NM 88021
Phone (575) 201-5135
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92487211 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L16882 | NM | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica de Familia, Incorporated | Past | Accepting new patients | |
| La Clinica de Familia, Incorporated | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Federally Qualified Health Center (FQHC)
- Las Cruces, NM
- NPI 1134917040
-
- Federally Qualified Health Center (FQHC)
- Las Cruces, NM
- NPI 1164802310
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548028800000",
"number": "1467950840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "385 CALLE DE ALEGRA STE A",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880053423",
"telephone_number": "575-526-1105",
"fax_number": "575-524-4266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 W GRIGGS AVE",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011235",
"telephone_number": "575-647-2800",
"fax_number": "575-647-2898"
}
],
"practiceLocations": [
{
"address_1": "826 Anthony Dr.",
"address_purpose": "LOCATION",
"city": "Anthony",
"state": "NM",
"postal_code": "88021",
"country_code": "US",
"telephone_number": "575-201-5135",
"fax_number": "575-201-5131",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "PAUL",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-31",
"last_updated": "2019-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NM",
"license": "L16882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "92487211",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.