Provider Demographics
NPI:1194984252
Name:RODRIGUEZ, ARTEMIO L (PA)
Entity type:Individual
Prefix:
First Name:ARTEMIO
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:STE 206
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4426
Mailing Address - Country:US
Mailing Address - Phone:760-883-1600
Mailing Address - Fax:760-520-6644
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:HAL B WALLIS BLDG
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-346-0642
Practice Address - Fax:760-340-9152
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2017-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19732OtherLICENSE