Healthcare Provider Details

I. General information

NPI: 1114112547
Provider Name (Legal Business Name): FRANCISCO JAVIER RODRIGUEZ JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 301
LAS CRUCES NM
88011-8262
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 301
LAS CRUCES NM
88011-8262
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-9755
  • Fax: 575-532-8881
Mailing address:
  • Phone: 575-532-9755
  • Fax: 575-532-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04447
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: