Provider Demographics
NPI:1831107572
Name:RODRIGUEZ, ROSA C (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 CENTRAL BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-544-6467
Mailing Address - Fax:956-544-6467
Practice Address - Street 1:2390 CENTRAL BLVD
Practice Address - Street 2:SUITE Q
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-544-6467
Practice Address - Fax:956-544-6467
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX653010Medicare ID - Type Unspecified