Healthcare Provider Details

I. General information

NPI: 1558942532
Provider Name (Legal Business Name): ANDREA LOPEZ-RODARTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 S MCCARRAN BLVD STE 5
RENO NV
89509-6129
US

IV. Provider business mailing address

PO BOX 511360
LOS ANGELES CA
90051-7915
US

V. Phone/Fax

Practice location:
  • Phone: 775-398-1981
  • Fax: 888-491-4526
Mailing address:
  • Phone: 775-398-1981
  • Fax: 775-398-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2365
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: