Provider Demographics
NPI:1619677820
Name:RODRIGUEZ, EDNA B
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:B
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14016 PETER NOYES DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5593
Mailing Address - Country:US
Mailing Address - Phone:915-297-1024
Mailing Address - Fax:
Practice Address - Street 1:14016 PETER NOYES DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-5593
Practice Address - Country:US
Practice Address - Phone:915-297-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant