Healthcare Provider Details

I. General information

NPI: 1841458072
Provider Name (Legal Business Name): AARON RODARTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 300
PHOENIX AZ
85050-4200
US

IV. Provider business mailing address

20950 N TATUM BLVD STE 300
PHOENIX AZ
85050-4200
US

V. Phone/Fax

Practice location:
  • Phone: 480-222-7246
  • Fax: 602-322-1684
Mailing address:
  • Phone: 480-222-7246
  • Fax: 602-322-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2918
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: