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NPI Code Detail

MEDICARE: MRS. CRISTINA MATA RODRIGUEZ PA-C

MEDICARE: MRS. CRISTINA MATA RODRIGUEZ PA-C
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
1363AM0700XMedical Physician AssistantPA11311TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA11311OTHERTXTEXAS MEDICAL BOARD LICENSE

General Provider Information

NPI Number : 1619492964
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRISTINA MATA RODRIGUEZ PA-C
Provider Business Mailing Address
First Line : PO BOX 4449
Second Line :
City : MCALLEN
State : TX
Zip : 78502-4449
Country : US
Telephone Number : 956-362-8460
Fax Number : 956-362-8455
Provider Business Practice Location Address
First Line : 4115 E LANCASTER AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-3614
Country : US
Telephone Number : 817-796-7370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 07/13/2020

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