Provider Demographics
NPI:1821329137
Name:RODRIGUEZ, TALITHA ANN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TALITHA
Middle Name:ANN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:TALITHA
Other - Middle Name:ANN
Other - Last Name:MARBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19200 SPACE CENTER BLVD
Mailing Address - Street 2:PHASE 1, APT. 713
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3736
Mailing Address - Country:US
Mailing Address - Phone:832-563-9819
Mailing Address - Fax:
Practice Address - Street 1:1322 SPACE PARK DR
Practice Address - Street 2:SUITE C185
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3400
Practice Address - Country:US
Practice Address - Phone:832-563-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01142171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist