MEDICARE: MRS. VANESSA M RODRIGUEZ PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10001486A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114173978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA M RODRIGUEZ PA

Provider Business Mailing Address
First Line	:	205 E 86TH CT
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6259
Country	:	US
Telephone Number	:	219-769-9070
Fax Number	:	219-769-1758

Provider Business Practice Location Address
First Line	:	205 E 86TH CT
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6259
Country	:	US
Telephone Number	:	219-769-9070
Fax Number	:	219-769-1758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	11/04/2014

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