Healthcare Provider Details

I. General information

NPI: 1932204955
Provider Name (Legal Business Name): ANA LUISA RODRIGUEZ, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 REDWOOD RD
SAN MARCOS TX
78666-9734
US

IV. Provider business mailing address

1605 REDWOOD RD
SAN MARCOS TX
78666-9734
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-1411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberH2172
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH2172
License Number StateTX

VIII. Authorized Official

Name: ANA L. RODRIGUEZ
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 512-392-1411