Provider Demographics
NPI:1306827860
Name:RODRIGUEZ, FAUSTO A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAUSTO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11355 MONTWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3883
Mailing Address - Country:US
Mailing Address - Phone:915-855-2454
Mailing Address - Fax:915-857-0492
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-521-7620
Practice Address - Fax:915-521-7842
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4215207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103904205OtherCIDC
TX103904203Medicaid
TX103900022Medicaid
NM76973Medicaid
TX8C9763Medicare PIN