1134299969 NPI number — MRS. PATRICIA JANE RODRIGUEZ PT

Table of content: MRS. PATRICIA JANE RODRIGUEZ PT (NPI 1134299969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134299969 NPI number — MRS. PATRICIA JANE RODRIGUEZ PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
PATRICIA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WENTWORTH
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134299969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 NE LOOP 410
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-832-8289
Provider Business Mailing Address Fax Number:
210-822-8263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 NE LOOP 410
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-832-8289
Provider Business Practice Location Address Fax Number:
210-822-8263
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1095958 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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