Provider Demographics
NPI:1447589932
Name:RODRIGUEZ, OLIVIA ROSARIO (RN, GNP, BC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSARIO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN, GNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 COUNTRY FLD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 N LOOP 1604 W
Practice Address - Street 2:STE 108-164
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4503
Practice Address - Country:US
Practice Address - Phone:210-479-1955
Practice Address - Fax:210-764-1561
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578308363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology