Provider Demographics
NPI:1528432135
Name:RODRIGUEZ, STEVEN MICHAEL (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4499 MEDICAL DR STE 166
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3771
Mailing Address - Country:US
Mailing Address - Phone:210-545-8485
Mailing Address - Fax:210-575-8537
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 166
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-575-8485
Practice Address - Fax:210-575-8537
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP129572363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354698801Medicaid
TX472590YLLWOtherMCR TPAN