=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134638372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELVIA RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2017
-----------------------------------------------------
Last Update Date | 09/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 E JEFFERSON ST
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-982-8578
-----------------------------------------------------
Fax | 956-982-8741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5238 LOS ARBOLES AVE
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-3879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-243-6552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 107257
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------