Provider Demographics
NPI:1962648857
Name:RODRIGUEZ, CRISELDA V (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CRISELDA
Middle Name:V
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-7010
Mailing Address - Country:US
Mailing Address - Phone:956-262-1037
Mailing Address - Fax:956-262-7756
Practice Address - Street 1:205 W EDINBURG AVE
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1769
Practice Address - Country:US
Practice Address - Phone:956-262-1037
Practice Address - Fax:956-262-7756
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208752224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183477202Medicaid
TX454880Medicare Oscar/Certification