Provider Demographics
NPI:1942071238
Name:ANDRADA, VANESSA RODRIGUEZ
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RODRIGUEZ
Last Name:ANDRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:RODRIGUEZ
Other - Last Name:ANDRADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:12410 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3230
Mailing Address - Country:US
Mailing Address - Phone:210-742-6555
Mailing Address - Fax:
Practice Address - Street 1:12410 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3230
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant