Provider Demographics
NPI:1275192395
Name:RODRIGUEZ-JAQUEZ, DANIELA IXMUCANE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:IXMUCANE
Last Name:RODRIGUEZ-JAQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:77 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5803
Practice Address - Country:US
Practice Address - Phone:805-269-1500
Practice Address - Fax:805-269-1585
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2024-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA56719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant