Provider Demographics
NPI:1669837944
Name:RAZO, RODOLFO JR
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:RAZO
Suffix:JR
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 1:2421 TAMESIS DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4346
Mailing Address - Country:US
Mailing Address - Phone:956-778-9096
Mailing Address - Fax:956-544-2569
Practice Address - Street 1:835 W PRICE RD STE 7
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8715
Practice Address - Country:US
Practice Address - Phone:956-455-1869
Practice Address - Fax:956-544-2569
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist