MEDICARE: ARACELY C RODRIGUEZ LSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	134781	OTHER		NBSTSA BOARD CERTIFICATION
2	SA00494	OTHER	TX	LSA LICENSE
3	12678965	OTHER	TX	CAQH
4	82NN17	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1093066615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARACELY C RODRIGUEZ LSA

Provider Business Mailing Address
First Line	:	7414 BROOKPORT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3528
Country	:	US
Telephone Number	:	956-346-7243
Fax Number	:	956-346-7243

Provider Business Practice Location Address
First Line	:	7414 BROOKPORT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3528
Country	:	US
Telephone Number	:	956-346-7243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2012
Last Update Date	:	06/16/2024

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Directions to “ ARACELY C RODRIGUEZ LSA” Practice Location

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