MEDICARE: REGINA RODRIGUEZ

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	101YP2500X	Professional Counselor	88616	TX

General Provider Information

NPI Number	:	1700508066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA RODRIGUEZ

Provider Business Mailing Address
First Line	:	12639 S HAUSMAN RD APT 7201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1107
Country	:	US
Telephone Number	:	915-599-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 VIEW DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-2436
Country	:	US
Telephone Number	:	210-375-9817
Fax Number	:

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

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	09/15/2022

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Directions to “ REGINA RODRIGUEZ ” Practice Location

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