Provider Demographics
NPI:1356470165
Name:RODRIGUEZ, JOSE A JR (SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5622
Mailing Address - Country:US
Mailing Address - Phone:915-887-3410
Mailing Address - Fax:915-592-7168
Practice Address - Street 1:8375 BURNHAM RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-1525
Practice Address - Country:US
Practice Address - Phone:915-599-6690
Practice Address - Fax:915-592-7168
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist