1275641292 NPI number — JESSICA RODRIGUEZ P.T.

Table of content: JESSICA RODRIGUEZ P.T. (NPI 1275641292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275641292 NPI number — JESSICA RODRIGUEZ P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275641292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7430 REMCON CIR
Provider Second Line Business Mailing Address:
STE. B110
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-544-2455
Provider Business Mailing Address Fax Number:
915-544-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9870 GATEWAY BLVD N
Provider Second Line Business Practice Location Address:
STE. B7
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79924-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-751-5245
Provider Business Practice Location Address Fax Number:
915-751-5255
Provider Enumeration Date:
08/29/2006

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:  1169500 , 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)





Copyright © 2007-2025 www.npivalidator.com