Individual provider Active NPI

David Lee Rodriquez, LPN

  • Licensed Practical Nurse
  • Santo Domingo Pueblo, NM
National Provider Identifier
1902630072
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
LPN-21817 Issued in NM
Practice address
100 NM Highway 22
Santo Domingo Pueblo, NM 87052-1249
Phone
(505) 404-5609
NPI assigned
Aug 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN-21817 NM Primary

Addresses

Primary practice location

100 NM Highway 22
Santo Domingo Pueblo, NM 87052-1249

Mailing address

411 Ross Ave
Hereford, TX 79045-5152
Phone (806) 853-4984

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

LicenseStateTypeSpecialty
LPN-21817NMMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1724889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1902630072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 ROSS AVE",
            "city": "HEREFORD",
            "state": "TX",
            "postal_code": "790455152",
            "telephone_number": "806-853-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NM HIGHWAY 22",
            "city": "SANTO DOMINGO PUEBLO",
            "state": "NM",
            "postal_code": "870521249",
            "telephone_number": "505-404-5609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIQUEZ",
        "first_name": "DAVID",
        "middle_name": "LEE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-29",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NM",
            "license": "LPN-21817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santo Domingo Pueblo, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.