Provider Demographics
NPI:1447397278
Name:RODRIGUEZ, JOSE ALFREDO (LSA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALFREDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 VISCOUNT BLVD
Mailing Address - Street 2:STE 242
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:915-203-3041
Mailing Address - Fax:
Practice Address - Street 1:8900 VISCOUNT BLVD
Practice Address - Street 2:STE 242
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-203-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLSA00SA50208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063JROtherBCBS