Healthcare Provider Details

I. General information

NPI: 1679754048
Provider Name (Legal Business Name): BETTY DEL RIO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FAIRMONT PKWY
PASADENA TX
77504-3013
US

IV. Provider business mailing address

6431 FANNIN ST JJL 495
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-6307
  • Fax: 281-487-0196
Mailing address:
  • Phone: 713-500-5666
  • Fax: 713-500-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN3004
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: