Healthcare Provider Details

I. General information

NPI: 1457535015
Provider Name (Legal Business Name): MARGARET T RODRIGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET T WILBER

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

1801 GEORGIA ST NE
ALBUQUERQUE NM
87110-5902
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2700
  • Fax:
Mailing address:
  • Phone: 774-253-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2019-0110
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: