Provider Demographics
NPI:1942207451
Name:RODRIGUEZ, JORGE OSVALDO (RVT/RVS)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:OSVALDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RVT/RVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-5216
Mailing Address - Country:US
Mailing Address - Phone:915-820-4190
Mailing Address - Fax:
Practice Address - Street 1:10470 VISTA DEL SOL DR
Practice Address - Street 2:STE 109
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7928
Practice Address - Country:US
Practice Address - Phone:915-629-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088028801Medicaid
00030011OtherCCI REG ID
38088OtherARDMS REGISTRY #
TX088028801Medicaid