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General NPI Number Information
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NPI Number | 1588151468
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Entity Type | Individual
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Provider Name | RICKY INOCENCIO RODRIGUEZ DO
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Gender | Male
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 333 N SANTA ROSA ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3108
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Country | US
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Telephone | 210-704-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N SAN SABA STE 1135
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City | SAN ANTONIO
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State | TX
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Zip | 78207-3255
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Country | US
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Telephone | 210-704-8878
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | V1246
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 678380
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 7250
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | V1246
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License Number State | TX
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