| Doctor Name: | MYRNA CRUZ RODERICK |
| NPI Number: | 1366703852 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 722471 |
| Business Practice Address: | 3145 Canterbury Ln Port Neches, TX - 776516219 |
| Business Phone Number: | 4098531703 |
| Business Fax Number: | 4098531703 |
| Mailing Address: | 3406 College St 100, BEAUMONT |
| State: | TX |
| Postal Code: | 777014612 |
| Phone Number: | 4098131677 |
| Fax Number: | 4097301399 |
| NPI Enumeration Date: | 05/31/2012 |
| NPI Last Update Date: | 08/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 722471 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |