Provider Demographics
NPI:1104665405
Name:RODRIGUEZ, SAMANTHA NICHOLE (RDN, LDN, MS)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICHOLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN, LDN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1335
Mailing Address - Country:US
Mailing Address - Phone:260-388-9461
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK DR STE 222
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2107
Practice Address - Country:US
Practice Address - Phone:806-673-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT89730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered