Individual
RODOLFO REALYVASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2240 WINROW RD, FORT HUACHUCA, AZ 85613-5080
(520) 533-9033
Mailing address
21 E BERRIDGE DR, SIERRA VISTA, AZ 85635-3117
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP034456
AZ
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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