Healthcare Provider Details

I. General information

NPI: 1609854090
Provider Name (Legal Business Name): RODRIGO CRESPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 US HIGHWAY 90 E
CASTROVILLE TX
78009
US

IV. Provider business mailing address

1051 US HIGHWAY 90 E
CASTROVILLE TX
78009-5210
US

V. Phone/Fax

Practice location:
  • Phone: 830-931-3336
  • Fax: 830-931-3508
Mailing address:
  • Phone: 830-931-3336
  • Fax: 830-931-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number203188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: