Provider Demographics
NPI:1780037978
Name:RODRIGUEZ, MARTHA P (PA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:P
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 LORENALY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4333
Mailing Address - Country:US
Mailing Address - Phone:956-545-0646
Mailing Address - Fax:956-545-0649
Practice Address - Street 1:345 LORENALY DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4333
Practice Address - Country:US
Practice Address - Phone:956-545-0646
Practice Address - Fax:956-545-0649
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant