Provider Demographics
NPI:1982868873
Name:RODRIGUEZ, JAIRO ALEJANDRO (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:ALEJANDRO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 WINDMILL PKWY
Mailing Address - Street 2:PMB 136
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-277-2370
Mailing Address - Fax:702-442-1870
Practice Address - Street 1:10422 RESEARCH FOREST DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6155
Practice Address - Country:US
Practice Address - Phone:832-702-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59805363A00000X
NY012535363A00000X
NVPA1120363AM0700X, 363AS0400X
TXPA16208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00980750OtherRAIL ROAD MEDICARE PIN
NVBK041ZMedicare PIN