MEDICARE: VANESSA RODRIGUEZ NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	1177068	TX

General Provider Information

NPI Number	:	1992523393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA RODRIGUEZ NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	13825 SUMMER STORY AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-2384
Country	:	US
Telephone Number	:	915-258-4295
Fax Number	:

Provider Business Practice Location Address
First Line	:	10765 KENWORTHY ST STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-1748
Country	:	US
Telephone Number	:	915-320-4021
Fax Number	:

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

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/03/2024

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Directions to “ VANESSA RODRIGUEZ NURSE PRACTITIONER” Practice Location

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