Provider Demographics
NPI:1932204955
Name:ANA LUISA RODRIGUEZ, MD PA
Entity Type:Organization
Organization Name:ANA LUISA RODRIGUEZ, MD PA
Other - Org Name:DERMATOLOGY & SKIN LASER CENTER AKA SAN MARCOS DERMATOLOGY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-392-1411
Mailing Address - Street 1:1605 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-9734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-9734
Practice Address - Country:US
Practice Address - Phone:512-392-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2172207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083875702Medicaid
TX=========OtherTAX IDENTIFICATION NUMBER
TX00L92LMedicare PIN
TXC21215Medicare UPIN