Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 426420 | TX |
NPI | 1003252859 |
---|---|
Provider Name | Delores Vait Rodriguez |
First Address | Laredo, TX 78043-2334 |
Second Address | Laredo, TX 78043-2334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 21/05/2013 |