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General NPI Number Information
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NPI Number | 1134990344
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Entity Type | Individual
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Provider Name | TIFFANY JAILENE COLON RODRIGUEZ MS
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Gender | Female
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 8012 SHIN OAK DR
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City | LIVE OAK
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State | TX
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Zip | 78233-2413
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Country | US
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Telephone | 210-945-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 8101 SHIN OAK DR APT 8200
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City | LIVE OAK
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State | TX
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Zip | 78233-2482
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Country | US
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Telephone | 787-469-0542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 120160
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License Number State | TX
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