=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477212470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANUEL GUADALUPE RODRIGUEZ APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2021
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3120 LA PITA MANGANA RD SUITE #100
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-568-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 HIBISCUS LN
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-231-3947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1056922
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------