Basic Information
| Provider Information | |||||||||
| NPI: | 1164575817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1966 INWOOD RD. | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149053010 | ||||||||
| FaxNumber: | 2149053022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1966 INWOOD RD. | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149053010 | ||||||||
| FaxNumber: | 2149053022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 80033 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 80033 | TX | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.