Healthcare Provider Details

I. General information

NPI: 1689251266
Provider Name (Legal Business Name): MERCEDES A RODRIGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PARK BEND DR STE 300
AUSTIN TX
78758-5674
US

IV. Provider business mailing address

2217 PARK BEND DR STE 300
AUSTIN TX
78758-5674
US

V. Phone/Fax

Practice location:
  • Phone: 512-382-1933
  • Fax: 512-778-8000
Mailing address:
  • Phone: 512-382-1933
  • Fax: 512-778-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: