MEDICARE: JEFFREY 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	246RM2200X	Medical Laboratory Technician	2317	TX

General Provider Information

NPI Number	:	1710741285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY RODRIGUEZ

Provider Business Mailing Address
First Line	:	11140 LA QUINTA PL # 101B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5227
Country	:	US
Telephone Number	:	915-494-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	11140 LA QUINTA PL STE 101B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5227
Country	:	US
Telephone Number	:	915-494-2611
Fax Number	:

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

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	08/05/2024

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Directions to “ JEFFREY RODRIGUEZ ” Practice Location

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