Provider Demographics
NPI:1487736583
Name:GARCIA, RODOLFO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:LUIS
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4504 S PROFESSIONAL DR APT 12307
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0073
Mailing Address - Country:US
Mailing Address - Phone:956-362-7553
Mailing Address - Fax:956-362-7510
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5503
Practice Address - Country:US
Practice Address - Phone:956-661-7100
Practice Address - Fax:956-362-7510
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL92042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167631407Medicaid
TX167631407Medicaid
TX8K5712Medicare PIN