Provider Demographics
NPI:1528764685
Name:RODRIGUEZ LORENZO, AGUSTIN ALEJANDRO (APRN-CNP)
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:ALEJANDRO
Last Name:RODRIGUEZ LORENZO
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 BLALOCK RD STE M
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5446
Mailing Address - Country:US
Mailing Address - Phone:832-831-4883
Mailing Address - Fax:346-319-2815
Practice Address - Street 1:1900 BLALOCK RD STE M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5446
Practice Address - Country:US
Practice Address - Phone:832-831-4883
Practice Address - Fax:346-319-2815
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1002033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily