Provider Demographics
NPI:1699927632
Name:RODRIGUEZ, ROSANNA RENEE (IDC)
Entity type:Individual
Prefix:MS
First Name:ROSANNA
Middle Name:RENEE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:MRS
Other - First Name:ROSANNA
Other - Middle Name:RENEE
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:2250 STANLEY RD
Mailing Address - Street 2:SUITE 36
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-2640
Mailing Address - Country:US
Mailing Address - Phone:210-295-8606
Mailing Address - Fax:210-221-1200
Practice Address - Street 1:2250 STANLEY RD
Practice Address - Street 2:SUITE 36
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-2640
Practice Address - Country:US
Practice Address - Phone:210-295-8606
Practice Address - Fax:210-221-1200
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman