Provider Demographics
NPI:1609854090
Name:CRESPO, RODRIGO
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:CRESPO
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 1:1051 US HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-5210
Mailing Address - Country:US
Mailing Address - Phone:830-931-3336
Mailing Address - Fax:830-931-3508
Practice Address - Street 1:1051 US HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009
Practice Address - Country:US
Practice Address - Phone:830-931-3336
Practice Address - Fax:830-931-3508
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11079919OtherCAQH
TX8L7605OtherMEDICARE
TX199707401Medicaid