Provider Demographics
NPI:1588279582
Name:RODRIGUEZ, MARCOS (CSFA/LSA)
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CSFA/LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 RIO HONDO RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3946
Mailing Address - Country:US
Mailing Address - Phone:956-428-2306
Mailing Address - Fax:
Practice Address - Street 1:1121 RIO HONDO RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3946
Practice Address - Country:US
Practice Address - Phone:956-428-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00616246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant