Provider Demographics
NPI:1497234496
Name:RODRIGUEZ, DOROTHY REGINA (911746 : RN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:REGINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:911746 : RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 LIBERTY STONE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3326 STRATFORD POINTE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7324
Practice Address - Country:US
Practice Address - Phone:210-724-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX911745163W00000X
TX911746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse