Provider Demographics
NPI:1942568324
Name:RODRIGUEZ, EVA L
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19775 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-3421
Mailing Address - Country:US
Mailing Address - Phone:210-681-0603
Mailing Address - Fax:
Practice Address - Street 1:14636 S FM 2790 W
Practice Address - Street 2:SUITE 4
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-4540
Practice Address - Country:US
Practice Address - Phone:210-681-0603
Practice Address - Fax:210-681-3992
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000732341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3113680-01Medicaid
TXAMB1288Medicare UPIN