Provider Demographics
NPI:1568656122
Name:RODRIGUEZ, MANUEL
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5331
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77491-5331
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:281-254-7923
Practice Address - Street 1:5314 SUMMIT LODGE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6033
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:281-254-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant