Provider Demographics
NPI:1598913808
Name:RODRIGUEZ, DIANA PATRICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PATRICIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 W SAHARA AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2754
Mailing Address - Country:US
Mailing Address - Phone:702-228-9888
Mailing Address - Fax:866-920-0799
Practice Address - Street 1:3802 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3112
Practice Address - Country:US
Practice Address - Phone:702-313-8446
Practice Address - Fax:702-384-8446
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1119OtherNV PA LICENSE