Provider Demographics
NPI:1225046121
Name:RODRIGUEZ, CARMELITA P (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELITA
Middle Name:P
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMALITA
Other - Middle Name:MEDINA
Other - Last Name:PASCUAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1730 SW MILITARY DR
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221
Mailing Address - Country:US
Mailing Address - Phone:210-924-7356
Mailing Address - Fax:210-924-0842
Practice Address - Street 1:1730 SW MILITARY DR
Practice Address - Street 2:STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221
Practice Address - Country:US
Practice Address - Phone:210-924-7356
Practice Address - Fax:210-924-0842
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104996701Medicaid
TXC21213Medicare UPIN
TX104996701Medicaid