Healthcare Provider Details

I. General information

NPI: 1487558540
Provider Name (Legal Business Name): EDDIE RENE RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MILL CREEK DR
ARLINGTON TX
76010-5617
US

IV. Provider business mailing address

2000 MILL CREEK DR
ARLINGTON TX
76010-5617
US

V. Phone/Fax

Practice location:
  • Phone: 619-373-4343
  • Fax:
Mailing address:
  • Phone: 619-373-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1141851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: