Provider Demographics
NPI:1669209789
Name:RODRIGUEZ ZUBIAUR, EDEL (SA-C)
Entity type:Individual
Prefix:
First Name:EDEL
Middle Name:
Last Name:RODRIGUEZ ZUBIAUR
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 GLADEWATER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1663
Mailing Address - Country:US
Mailing Address - Phone:612-380-2618
Mailing Address - Fax:
Practice Address - Street 1:5927 GLADEWATER RIDGE LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1663
Practice Address - Country:US
Practice Address - Phone:612-380-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-313246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant