Provider Demographics
NPI:1871849042
Name:RODRIGUEZ, LESLIE RAY (RN, ACNS-BC, APRN)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:RAY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RN, ACNS-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 GASTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2026
Mailing Address - Country:US
Mailing Address - Phone:214-865-1573
Mailing Address - Fax:214-865-1580
Practice Address - Street 1:3500 GASTON AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2026
Practice Address - Country:US
Practice Address - Phone:214-820-0111
Practice Address - Fax:214-865-1580
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522482163WP0000X, 364S00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health