Healthcare Provider Details

I. General information

NPI: 1275901142
Provider Name (Legal Business Name): MARIA RODRIGUEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S MOON AVE
BRANDON FL
33511-5711
US

IV. Provider business mailing address

270 S MOON AVE
BRANDON FL
33511-5711
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-9988
  • Fax:
Mailing address:
  • Phone: 813-571-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9108959
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: