Provider Demographics
NPI:1043788201
Name:DSW PEDIATRICS & CHILDREN AND YOUTH CLINIC
Entity Type:Organization
Organization Name:DSW PEDIATRICS & CHILDREN AND YOUTH CLINIC
Other - Org Name:JOSELITA RODRIGUEZ M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-298-1878
Mailing Address - Street 1:2727 BOLTON BOONE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:972-298-1878
Mailing Address - Fax:972-298-1952
Practice Address - Street 1:2727 BOLTON BOONE DR STE 111
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-298-1878
Practice Address - Fax:972-298-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty