Healthcare Provider Details

I. General information

NPI: 1952512246
Provider Name (Legal Business Name): SIMON SERGIO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MURCHISON DRIVE SUITE 100
EL PASO TX
79902
US

IV. Provider business mailing address

1310 MURCHISON DRIVE SUITE 100
EL PASO TX
79902
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-4500
  • Fax: 915-544-4572
Mailing address:
  • Phone: 915-544-4500
  • Fax: 915-546-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberN5366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: