Provider Demographics
NPI:1376728188
Name:RODRIGUEZ, ANNA MARIE (RD, CSR, LD)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD, CSR, LD
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:JOAS-ROCKHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TX
Mailing Address - Zip Code:78058-0105
Mailing Address - Country:US
Mailing Address - Phone:830-866-3634
Mailing Address - Fax:830-866-3634
Practice Address - Street 1:159 NW ROUGH CREEK RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TX
Practice Address - Zip Code:78058-0105
Practice Address - Country:US
Practice Address - Phone:830-866-3634
Practice Address - Fax:830-866-3634
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05346133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered