Healthcare Provider Details

I. General information

NPI: 1366829202
Provider Name (Legal Business Name): ORLANDO RODRIGUEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 AUSTIN HWY STE 214
SAN ANTONIO TX
78209
US

IV. Provider business mailing address

2961 MOSSROCK
SAN ANTONIO TX
78230-5119
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-2531
  • Fax: 210-828-2532
Mailing address:
  • Phone: 210-731-4800
  • Fax: 210-731-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ9239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: