Provider Demographics
NPI:1417459579
Name:FAURE RODRIGUEZ, FRAIDELYS (SA-C , IMG)
Entity Type:Individual
Prefix:
First Name:FRAIDELYS
Middle Name:
Last Name:FAURE RODRIGUEZ
Suffix:
Gender:F
Credentials:SA-C , IMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24115 STARGAZER PT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7899
Mailing Address - Country:US
Mailing Address - Phone:281-662-6609
Mailing Address - Fax:
Practice Address - Street 1:24115 STARGAZER PT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7899
Practice Address - Country:US
Practice Address - Phone:281-662-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-633246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant