Healthcare Provider Details

I. General information

NPI: 1952251282
Provider Name (Legal Business Name): LUIS ALAN RODRIGUEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13402 N 32ND ST
PHOENIX AZ
85032-6047
US

IV. Provider business mailing address

13402 N 32ND ST
PHOENIX AZ
85032-6047
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-3999
  • Fax:
Mailing address:
  • Phone: 602-569-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1248934
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: