Individual
MR. RODOLFO C NELLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17505 N 79TH AVE STE 201, GLENDALE, AZ 85308
(623) 236-9295
(623) 236-8819
Mailing address
17505 N 79TH AVE STE 201, GLENDALE, AZ 85308
(623) 236-9295
(623) 236-8819
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12395
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04304
BLUE CROSS BLUE SHIELD-AZ
AZ
Enumeration date
08/16/2005
Last updated
10/18/2017
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