Provider Demographics
NPI:1972494276
Name:RODRIGUEZ, VANESSA NICOLE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICOLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BOB BULLOCK LOOP APT 13201
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4373
Mailing Address - Country:US
Mailing Address - Phone:956-739-9389
Mailing Address - Fax:
Practice Address - Street 1:1937 E BUSTAMANTE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5416
Practice Address - Country:US
Practice Address - Phone:967-739-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant