Provider Demographics
NPI:1679235519
Name:RODRIGUEZ ALONSO, YENNYS
Entity Type:Individual
Prefix:
First Name:YENNYS
Middle Name:
Last Name:RODRIGUEZ ALONSO
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 1:2741 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-7131
Mailing Address - Country:US
Mailing Address - Phone:817-386-9926
Mailing Address - Fax:817-386-9907
Practice Address - Street 1:2741 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7131
Practice Address - Country:US
Practice Address - Phone:817-386-9926
Practice Address - Fax:817-386-9907
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056306363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology