Provider Demographics
NPI:1689617540
Name:RODRIGUEZ, ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMDEN ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2012
Mailing Address - Country:US
Mailing Address - Phone:210-591-1615
Mailing Address - Fax:210-591-1635
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-591-1615
Practice Address - Fax:210-591-1635
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK22722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047567502Medicaid
TX047567501Medicaid
TX047567501Medicaid
TX047567502Medicaid
TX611762Medicare ID - Type UnspecifiedSOLO