Provider Demographics
NPI:1982283487
Name:RODRIGUEZ, IRMA CAROLINA
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:CAROLINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:CAROLINA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 TANGERINE BLVD TRLR 94
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4345
Mailing Address - Country:US
Mailing Address - Phone:956-408-5902
Mailing Address - Fax:
Practice Address - Street 1:100 TANGERINE BLVD TRLR 94
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4345
Practice Address - Country:US
Practice Address - Phone:956-408-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39881231OtherDRIVERS LICENSE