Provider Demographics
NPI:1649755018
Name:RODRIGUEZ, ISABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
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 1:8045 W CAMP WISDOM RD APT 6102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-5718
Mailing Address - Country:US
Mailing Address - Phone:806-543-5414
Mailing Address - Fax:
Practice Address - Street 1:151 RVG PKWY STE 103
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5241
Practice Address - Country:US
Practice Address - Phone:469-383-7323
Practice Address - Fax:866-816-0795
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant