Provider Demographics
NPI:1972734234
Name:RODAS OCHOA, FABIAN VICENTE (MD)
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:VICENTE
Last Name:RODAS OCHOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CAMDEN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2100
Mailing Address - Country:US
Mailing Address - Phone:210-253-3426
Mailing Address - Fax:210-237-4807
Practice Address - Street 1:607 CAMDEN ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215
Practice Address - Country:US
Practice Address - Phone:210-253-3426
Practice Address - Fax:210-237-4807
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4312207R00000X
FLME111979282N00000X
NC2016-00415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCS507AMedicare PIN
SCNC2733Medicaid
NCNCS507AMedicare PIN
NC1972734234Medicaid