Provider Demographics
NPI:1255415832
Name:RODRIGUEZ, URSULA SALOME (NP)
Entity type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:SALOME
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:URSULA
Other - Middle Name:SALOME
Other - Last Name:OBLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:713-791-1414
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L6387OtherMEDICARE PTAN
TX8Y3615OtherBCBS
TX8L6388OtherMEDICARE PTAN
F0305288OtherANNP CERT #
TX8L6386OtherMEDICARE PTAN