Provider Demographics
NPI:1962453902
Name:RODRIGUEZ, DORA ELVA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:ELVA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ZINFANDEL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2862
Mailing Address - Country:US
Mailing Address - Phone:916-638-4000
Mailing Address - Fax:916-638-0745
Practice Address - Street 1:1995 ZINFANDEL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2862
Practice Address - Country:US
Practice Address - Phone:916-638-4000
Practice Address - Fax:916-638-0745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16135OtherCALIFORNIA LICENSE NUMBER