Rodolfo C Nellas, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

12395 Issued in AZ

Practice address

17505 N 79TH Ave Ste 201
Glendale, AZ 85308

Phone

(623) 236-9295

Fax

(623) 236-8819

NPI assigned

Aug 16, 2005

Last updated

Oct 18, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508284800000",
    "number": "1609868611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 201",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-236-9295",
            "fax_number": "623-236-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 201",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-236-9295",
            "fax_number": "623-236-8819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18301 N. 79th Ave",
            "address_2": "F170",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "85308",
            "country_code": "US",
            "telephone_number": "623-236-9295",
            "fax_number": "623-236-9295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELLAS",
        "first_name": "RODOLFO",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "12395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD-AZ",
            "identifier": "04304",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neighborhood Outreach Access to Health (Copperwood II Health Center)
• Neighborhood Outreach Access to Health (NOAH's Copperwood Pharmacy)
• Neighborhood Outreach Access to Health (Copperwood Health Center)
• Rhonda Nell, O.D.
• Ralph Nellas, PHARMD
• Nelson Family Dentistry, PC
• Anthony Dominic Nelson, PA-C
• Jacque Catalano Nelson, MOTR.L
• Julie Anne Nelson, RDN
• Kimberly Nelson, PA-C

• Specialist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.