MEDICARE: RODNEY MINGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	23322276	TX

General Provider Information

NPI Number	:	1396500419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY MINGO

Provider Business Mailing Address
First Line	:	17815 POPPY TRAILS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1071
Country	:	US
Telephone Number	:	832-581-8737
Fax Number	:

Provider Business Practice Location Address
First Line	:	17815 POPPY TRAILS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1071
Country	:	US
Telephone Number	:	832-581-8737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	02/19/2024

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Directions to “ RODNEY MINGO ” Practice Location

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