Provider Demographics
NPI:1013699636
Name:ROJAS, MARIAGRACIA LUCIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAGRACIA
Middle Name:LUCIA
Last Name:ROJAS
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 1:2703 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3967
Mailing Address - Country:US
Mailing Address - Phone:571-499-7816
Mailing Address - Fax:
Practice Address - Street 1:3541 RANDOLPH RD STE 303
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5122
Practice Address - Country:US
Practice Address - Phone:704-333-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant