Provider Demographics
NPI:1689692931
Name:RODRIGUEZ, JOSELITA D (MD)
Entity Type:Individual
Prefix:
First Name:JOSELITA
Middle Name:D
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 1:2727 BOLTON BOONE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:972-298-1878
Mailing Address - Fax:972-298-1952
Practice Address - Street 1:2727 BOLTON BOONE DR STE 111
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-298-1878
Practice Address - Fax:972-298-1952
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125088807Medicaid
TX141022701Medicaid
TX125088805Medicaid
TX141022701Medicaid
TXE20068Medicare UPIN
TX8J6120Medicare PIN