Provider Demographics
NPI:1811638067
Name:MELARA, RODRIGO ANTONIO (PA)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:ANTONIO
Last Name:MELARA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19614 RIVER POINTE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4735
Mailing Address - Country:US
Mailing Address - Phone:713-391-0476
Mailing Address - Fax:
Practice Address - Street 1:19614 RIVER POINTE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4735
Practice Address - Country:US
Practice Address - Phone:713-391-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1220-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical