Healthcare Provider Details

I. General information

NPI: 1669660882
Provider Name (Legal Business Name): RYAN MICHAEL RODRIGUEZ PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E REDD RD BLDG B
EL PASO TX
79912-7275
US

IV. Provider business mailing address

820 E REDD RD BLDG B
EL PASO TX
79912-7275
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-581-0712
Mailing address:
  • Phone: 915-581-0712
  • Fax: 915-533-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60229753
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: