MEDICARE: MR. LESLIE RAY RODRIGUEZ RN, ACNS-BC, APRN

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	163WP0000X	Pain Management Registered Nurse	522482	TX
2	364S00000X	Clinical Nurse Specialist	522482	TX
3	364SA2200X	Adult Health Clinical Nurse Specialist	522482	TX

General Provider Information

NPI Number	:	1871849042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESLIE RAY RODRIGUEZ RN, ACNS-BC, APRN

Provider Business Mailing Address
First Line	:	3500 GASTON AVENUE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2026
Country	:	US
Telephone Number	:	214-865-1573
Fax Number	:	214-865-1580

Provider Business Practice Location Address
First Line	:	3500 GASTON AVENUE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2026
Country	:	US
Telephone Number	:	214-820-0111
Fax Number	:	214-865-1580

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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