Provider Demographics
NPI:1396132767
Name:RODRIGUEZ, KEILA (MD)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 N 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2114
Mailing Address - Country:US
Mailing Address - Phone:956-296-1960
Mailing Address - Fax:
Practice Address - Street 1:6500 N 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2114
Practice Address - Country:US
Practice Address - Phone:956-833-2142
Practice Address - Fax:888-440-5768
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6663208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3844763-08Medicaid
TXH08MP07801OtherBCBS