Healthcare Provider Details

I. General information

NPI: 1235345109
Provider Name (Legal Business Name): DHARMA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5368 FREDERICKSBURG RD SUITE 200
SAN ANTONIO TX
78229-6108
US

IV. Provider business mailing address

5368 FREDERICKSBURG RD SUITE 200
SAN ANTONIO TX
78229-6108
US

V. Phone/Fax

Practice location:
  • Phone: 219-349-0096
  • Fax: 210-349-0097
Mailing address:
  • Phone: 219-349-0096
  • Fax: 210-349-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number04271LCSW
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: