Provider Demographics
NPI:1023827920
Name:RODRIGUEZ, JAVIER ALFONSO
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:ALFONSO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25399 THE OLD RD APT 14203
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1628
Mailing Address - Country:US
Mailing Address - Phone:805-276-2780
Mailing Address - Fax:
Practice Address - Street 1:11330 FARRAH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1959
Practice Address - Country:US
Practice Address - Phone:512-280-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist