Provider Demographics
NPI:1558730523
Name:RODRIGUEZ, ORLANDO SR (LSA)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:SR
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 1:2202 TORRENTE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2197
Mailing Address - Country:US
Mailing Address - Phone:346-234-5389
Mailing Address - Fax:
Practice Address - Street 1:2202 TORRENTE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2197
Practice Address - Country:US
Practice Address - Phone:346-234-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TX15-398246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00626OtherLSA - TEXAS MEDICAL BOARD
TX8HL052OtherBCBS - XCITE SURGICAL
TX8HL052OtherBCBS - XCITE SURGICAL
TXSA00626OtherLSA - TEXAS MEDICAL BOARD