Provider Demographics
NPI:1205644093
Name:RODRIGUEZ, VERONICA R (AE-C)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:280 FLOWER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-1537
Mailing Address - Country:US
Mailing Address - Phone:817-938-5502
Mailing Address - Fax:
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-927-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678222279P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Function TechnologistGroup - Single Specialty