Provider Demographics
NPI:1316350796
Name:RODRIGUEZ, LALA CORINA (PA-C)
Entity type:Individual
Prefix:MS
First Name:LALA
Middle Name:CORINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1030 E EL CAMINO REAL
Mailing Address - Street 2:PMB 163
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3759
Mailing Address - Country:US
Mailing Address - Phone:806-283-2652
Mailing Address - Fax:
Practice Address - Street 1:1030 E EL CAMINO REAL
Practice Address - Street 2:PMB 163
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3759
Practice Address - Country:US
Practice Address - Phone:806-283-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA51632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant