Provider Demographics
NPI:1235161027
Name:RODRIGUEZ, ERNESTO ALONZO (CRNA)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ALONZO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 W 5TH STREET
Mailing Address - Street 2:PMB 304
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072
Mailing Address - Country:US
Mailing Address - Phone:806-283-7989
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:320 N MAIN
Practice Address - Street 2:
Practice Address - City:LOCKNEY
Practice Address - State:TX
Practice Address - Zip Code:79241
Practice Address - Country:US
Practice Address - Phone:806-652-3373
Practice Address - Fax:806-652-2417
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526665163W00000X
NMCRNA00638367500000X
TX047961367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y5244OtherBCBS OF TEXAS
TX088734109Medicaid
TX088734109Medicaid