Healthcare Provider Details

I. General information

NPI: 1861797995
Provider Name (Legal Business Name): CYNTHIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 NE LOOP 410 STE 610
SAN ANTONIO TX
78216-5866
US

IV. Provider business mailing address

6211 CRAKSTON ST
HOUSTON TX
77084-2019
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-7560
  • Fax: 800-437-7561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number109621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: