Provider Demographics
NPI:1295908119
Name:RODRIGUEZ, MARQUITA (PA)
Entity type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2383 2ND AVE APT 2701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2356
Mailing Address - Country:US
Mailing Address - Phone:212-965-4826
Mailing Address - Fax:718-585-8275
Practice Address - Street 1:349 E 149TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5603
Practice Address - Country:US
Practice Address - Phone:212-965-4826
Practice Address - Fax:718-585-8275
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007488-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant