Provider Demographics
NPI:1801333950
Name:RODRIGUEZ, MONICA LIZA (NP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LIZA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W SAINT PETER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:TX
Mailing Address - Zip Code:78384-3037
Mailing Address - Country:US
Mailing Address - Phone:361-296-4880
Mailing Address - Fax:
Practice Address - Street 1:111 E. RILEY ST.
Practice Address - Street 2:
Practice Address - City:FREER
Practice Address - State:TX
Practice Address - Zip Code:78357
Practice Address - Country:US
Practice Address - Phone:361-394-7311
Practice Address - Fax:361-394-7158
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily