Active NPI
Carlos Jose Rodriguez, PHD
- Psychologist
- Pueblo, CO
National Provider Identifier
1841304185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1004
- Practice address
- 1301 W 17TH Street
Pueblo, CO 81003-1915 - Phone
- (719) 545-5211
- Fax
- (719) 545-1962
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1004 | CO | Primary |
Addresses
Primary practice location
1301 W 17TH Street
Pueblo, CO 81003-1915
Mailing address
PO Box 3336
Pueblo, CO 81005-0336
Phone (719) 545-5211
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07109952 | Medicaid | CO | |
| 007928 | Medicaid | CO |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1004 | CO | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Senior Harbors, Inc. | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Pueblo, CO
- NPI 1114009198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204156800000",
"number": "1841304185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3336",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810050336",
"telephone_number": "719-545-5211",
"fax_number": "719-545-1962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W 17TH STREET",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810031915",
"telephone_number": "719-545-5211",
"fax_number": "719-545-1962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "CARLOS",
"middle_name": "JOSE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2008-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "1004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "07109952",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007928",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.