MEDICARE: CESAR JR RODRIGUEZ CNA

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	376K00000X	Nurse's Aide	NA0060027715	TX

General Provider Information

NPI Number	:	1265924567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR JR RODRIGUEZ CNA

Provider Business Mailing Address
First Line	:	3741 LONGSTRAW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1638
Country	:	US
Telephone Number	:	817-371-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 LONGSTRAW DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1638
Country	:	US
Telephone Number	:	817-371-2676
Fax Number	:

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

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	06/01/2018

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