Provider Demographics
NPI:1548863699
Name:RODRIGUEZ, CARLOS FERNANDO JR
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:FERNANDO
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E SAN PEDRO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5429
Mailing Address - Country:US
Mailing Address - Phone:956-701-3066
Mailing Address - Fax:
Practice Address - Street 1:1520 E SAN PEDRO ST STE 202
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5429
Practice Address - Country:US
Practice Address - Phone:956-701-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80950237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist