Healthcare Provider Details

I. General information

NPI: 1073747275
Provider Name (Legal Business Name): GIDEAO RODRIGUES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

4032 HICKORY AVE
MCALLEN TX
78501-8183
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax:
Mailing address:
  • Phone: 956-687-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberP4375
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberP4375
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP4375
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: