MEDICARE: KARLA LIZETTE RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	986988	TX

General Provider Information

NPI Number	:	1124642137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA LIZETTE RODRIGUEZ

Provider Business Mailing Address
First Line	:	3215 W CESAR E CHAVEZ BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-4023
Country	:	US
Telephone Number	:	210-937-2104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 W CESAR E CHAVEZ BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-4023
Country	:	US
Telephone Number	:	210-937-2104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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Directions to “ KARLA LIZETTE RODRIGUEZ ” Practice Location

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