Provider Demographics
NPI:1285653089
Name:RODRIGUEZ-CHEVRES, ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RODRIGUEZ-CHEVRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 BROWN ST
Practice Address - Street 2:2-B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4727
Practice Address - Country:US
Practice Address - Phone:915-533-7755
Practice Address - Fax:915-542-2978
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH35132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMY8495Medicaid
TXZ000L69L8Medicaid
NMK8986Medicaid
TXP085V5502Medicaid
NMK8986Medicaid
TX85V550Medicare ID - Type UnspecifiedINDIVIDUAL TX MEDICARE NO
TX00L69LMedicare ID - Type UnspecifiedGROUP TX MEDICARE NO.