MEDICARE: MIRANDA LIN 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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1295386456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LIN RODRIGUEZ

Provider Business Mailing Address
First Line	:	7402 GALLOP DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-2744
Country	:	US
Telephone Number	:	210-803-3931
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 SKYBOUND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-4648
Country	:	US
Telephone Number	:	210-803-3931
Fax Number	:

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

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	09/27/2019

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Directions to “ MIRANDA LIN RODRIGUEZ ” Practice Location

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