Provider Demographics
NPI:1427308113
Name:RODRIGUEZ, VICTORIA A (RN, FPMHNP-BC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN, FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:7TH FL - INPATIENT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-1260
Practice Address - Fax:210-358-4020
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX596654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307113601Medicaid
TX307113602OtherMEDICAID CSHCN
TX307113602OtherMEDICAID CSHCN