1437179314 NPI number — DR. RUBEN RODRIGUEZ JR. D.D.S

Table of content: ALEXON CHAU TIEM (NPI 1346023314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437179314 NPI number — DR. RUBEN RODRIGUEZ JR. D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
RUBEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.D.S
Provider Gender Code:
M

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:
1437179314
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:
PO BOX 769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78573-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-849-7050
Provider Business Mailing Address Fax Number:
956-849-1435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 E BRAVO BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ROMA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78584-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-849-7050
Provider Business Practice Location Address Fax Number:
956-849-1435
Provider Enumeration Date:
07/20/2006

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: 1223G0001X , with the licence number:  17298 , 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)

  • Identifier: B17298-01 . This is a "DELTA DENTAL TX CHIP PROG" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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