Provider Demographics
NPI:1043782600
Name:RODRIGUEZ MATOS, IBRAHIN (RN)
Entity Type:Individual
Prefix:
First Name:IBRAHIN
Middle Name:
Last Name:RODRIGUEZ MATOS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GULFTON ST APT 3117
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2519
Mailing Address - Country:US
Mailing Address - Phone:832-342-4575
Mailing Address - Fax:
Practice Address - Street 1:5825 GULFTON ST APT 3117
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2519
Practice Address - Country:US
Practice Address - Phone:832-342-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX950698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse