Healthcare Provider Details

I. General information

NPI: 1780708149
Provider Name (Legal Business Name): JUAN ALEXIS RODRIGUEZ JR. R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER BOULEVARD
SAN ANTONIO TX
78244
US

IV. Provider business mailing address

5750 SPRING SUN
SAN ANTONIO TX
78244-3289
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-661-6203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number92036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: