Provider Demographics
NPI:1801866249
Name:RODRIGUEZ, RAFAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:341 WHEATFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4639
Mailing Address - Country:US
Mailing Address - Phone:972-285-0221
Mailing Address - Fax:972-285-0223
Practice Address - Street 1:341 WHEATFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4639
Practice Address - Country:US
Practice Address - Phone:972-285-0221
Practice Address - Fax:972-285-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096435502Medicaid
TXG36085Medicare UPIN
TX8F4013Medicare PIN