Provider Demographics
NPI:1558838458
Name:RODRIGUEZ, MARIO RONAIRE YUZON (RN)
Entity type:Individual
Prefix:
First Name:MARIO RONAIRE
Middle Name:YUZON
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 CASTLE PEAK LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5820
Mailing Address - Country:US
Mailing Address - Phone:607-341-0881
Mailing Address - Fax:
Practice Address - Street 1:6116 CASTLE PEAK LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5820
Practice Address - Country:US
Practice Address - Phone:607-341-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX749269163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse