Provider Demographics
NPI:1790324689
Name:RODRIGUEZ, BRENDA GONZALEZ
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:GONZALEZ
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 1:13007 WELLINGTON
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2201
Mailing Address - Country:US
Mailing Address - Phone:915-241-6894
Mailing Address - Fax:
Practice Address - Street 1:13007 WELLINGTON
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-2201
Practice Address - Country:US
Practice Address - Phone:915-241-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765808163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
765808OtherRN