Provider Demographics
NPI:1073223822
Name:RODRIGUEZ, JOMAR
Entity Type:Individual
Prefix:
First Name:JOMAR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BENMAR DR APT 142
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2909
Mailing Address - Country:US
Mailing Address - Phone:346-505-2234
Mailing Address - Fax:
Practice Address - Street 1:301 BENMAR DR APT 142
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2909
Practice Address - Country:US
Practice Address - Phone:346-505-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator