Individual
AUDREY DIANE RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
9102 FLOYD CURL DR, SAN ANTONIO, TX 78240-1553
(210) 782-9528
(512) 597-0841
Mailing address
215 E QUINCY ST, SUITE B100, SAN ANTONIO, TX 78215-2039
(210) 299-8000
(210) 299-8099
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06859
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB157669
MEDICARE PTAN
TX
Enumeration date
02/08/2011
Last updated
11/16/2016
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