Provider Demographics
NPI:1295854461
Name:RODRIGUEZ, CHRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:ESCONTRIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 COPPER CREST LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1925
Mailing Address - Country:US
Mailing Address - Phone:915-203-6592
Mailing Address - Fax:915-857-9452
Practice Address - Street 1:14 COPPER CREST LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1925
Practice Address - Country:US
Practice Address - Phone:915-203-6592
Practice Address - Fax:915-857-9452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05204363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J9190Medicare PIN