Provider Demographics
NPI:1356732267
Name:RODRIGUEZ, JAYCE (PA-C)
Entity type:Individual
Prefix:
First Name:JAYCE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JAYCE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2405 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3513
Mailing Address - Country:US
Mailing Address - Phone:575-243-8084
Mailing Address - Fax:
Practice Address - Street 1:2405 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3513
Practice Address - Country:US
Practice Address - Phone:575-243-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2025-03-11
Deactivation Date:2017-12-06
Deactivation Code:
Reactivation Date:2017-12-13
Provider Licenses
StateLicense IDTaxonomies
NMPA2024-0147363A00000X
TXPA09524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant