Healthcare Provider Details

I. General information

NPI: 1134748627
Provider Name (Legal Business Name): JASMINE KATE RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 12/12/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 SARATOGA BLVD STE 200
CORPUS CHRISTI TX
78414-4252
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-5098
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-4600
  • Fax:
Mailing address:
  • Phone: 903-606-6400
  • Fax: 903-606-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU7753
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: