MEDICARE: DR. VIVIAN ODETTE RODRIGUEZ M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	J2980	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578511192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN ODETTE RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	2201 W HOLCOMBE BLVD
Second Line	:	STE 245
City	:	HOUSTON
State	:	TX
Zip	:	77030-2032
Country	:	US
Telephone Number	:	713-796-1188
Fax Number	:	713-796-1388

Provider Business Practice Location Address
First Line	:	2201 W HOLCOMBE BLVD
Second Line	:	STE 245
City	:	HOUSTON
State	:	TX
Zip	:	77030-2096
Country	:	US
Telephone Number	:	713-796-1188
Fax Number	:	713-796-1388

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/18/2022

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