Provider Demographics
NPI:1578511192
Name:RODRIGUEZ, VIVIAN ODETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:ODETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 W HOLCOMBE BLVD
Mailing Address - Street 2:STE 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2032
Mailing Address - Country:US
Mailing Address - Phone:713-796-1188
Mailing Address - Fax:713-796-1388
Practice Address - Street 1:2201 W HOLCOMBE BLVD
Practice Address - Street 2:STE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2096
Practice Address - Country:US
Practice Address - Phone:713-796-1188
Practice Address - Fax:713-796-1388
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2980207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145230201Medicaid
TX145230201Medicaid
TX8996M0Medicare PIN