Provider Demographics
NPI:1093066615
Name:RODRIGUEZ, ARACELY C (LSA)
Entity type:Individual
Prefix:
First Name:ARACELY
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7414 BROOKPORT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3528
Mailing Address - Country:US
Mailing Address - Phone:956-346-7243
Mailing Address - Fax:956-346-7243
Practice Address - Street 1:7414 BROOKPORT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3528
Practice Address - Country:US
Practice Address - Phone:956-346-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TX134781363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
134781OtherNBSTSA BOARD CERTIFICATION
TXSA00494OtherLSA LICENSE
TX12678965OtherCAQH
TX82NN17OtherBCBS