Provider Demographics
NPI:1780708149
Name:RODRIGUEZ, JUAN ALEXIS JR (RT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ALEXIS
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:RT
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:5750 SPRING SUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-3289
Mailing Address - Country:US
Mailing Address - Phone:210-661-6203
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92036247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist