Provider Demographics
NPI:1306456736
Name:RODRIGUEZ CARRALERO, YUDISLEIDY
Entity type:Individual
Prefix:
First Name:YUDISLEIDY
Middle Name:
Last Name:RODRIGUEZ CARRALERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 TULLICH RUN DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4624
Mailing Address - Country:US
Mailing Address - Phone:281-492-4499
Mailing Address - Fax:
Practice Address - Street 1:12411 TULLICH RUN DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4624
Practice Address - Country:US
Practice Address - Phone:281-492-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1306456736363L00000X
TX984522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse