Provider Demographics
NPI:1184516106
Name:RODRIGUEZ, ANTHONY XAVIER JR
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:XAVIER
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 REED CT APT 3A
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5180
Mailing Address - Country:US
Mailing Address - Phone:312-581-2564
Mailing Address - Fax:
Practice Address - Street 1:3400 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-1101
Practice Address - Country:US
Practice Address - Phone:219-980-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program