Provider Demographics
NPI:1477212470
Name:RODRIGUEZ, MANUEL GUADALUPE (APRN)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:GUADALUPE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HIBISCUS LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3320
Mailing Address - Country:US
Mailing Address - Phone:956-231-3947
Mailing Address - Fax:
Practice Address - Street 1:3120 LA PITA MANGANA RD
Practice Address - Street 2:SUITE #100
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046
Practice Address - Country:US
Practice Address - Phone:956-568-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily