MEDICARE: TARA RENEE ROJAS-PADRON PA-C

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	363AS0400X	Surgical Physician Assistant	PA10825	TX
2	363A00000X	Physician Assistant	PA 10825	TX

General Provider Information

NPI Number	:	1295262087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA RENEE ROJAS-PADRON PA-C

Provider Business Mailing Address
First Line	:	4330 MEDICAL DR STE 325
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3389
Country	:	US
Telephone Number	:	210-615-7700
Fax Number	:	210-614-1782

Provider Business Practice Location Address
First Line	:	14603 HUEBNER RD STE 28101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5497
Country	:	US
Telephone Number	:	210-614-7074
Fax Number	:	210-614-7091

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	01/04/2022

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Directions to “ TARA RENEE ROJAS-PADRON PA-C” Practice Location

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