Basic Information
| Provider Information | |||||||||
| NPI: | 1871849042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, ACNS-BC, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 GASTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148651573 | ||||||||
| FaxNumber: | 2148651580 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 GASTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752462026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148200111 | ||||||||
| FaxNumber: | 2148651580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0000X | 522482 | TX | N | Nursing Service Providers | Registered Nurse | Pain Management | 364S00000X | 522482 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 364SA2200X | 522482 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.