Provider Demographics
NPI:1003819855
Name:RODRIGUEZ VARGAS, JAMES ENRIQUE (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ENRIQUE
Last Name:RODRIGUEZ VARGAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 RIVERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2415
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-757-1640
Practice Address - Street 1:6974 GATEWAY BLVD E
Practice Address - Street 2:STE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1115
Practice Address - Country:US
Practice Address - Phone:915-591-2704
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ26706Medicare UPIN
TX8C7138Medicare ID - Type UnspecifiedEL PASO HEALTH MASTERS