Provider Demographics
NPI:1386074359
Name:RODRIGUEZ, CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 RED ROAD
Mailing Address - Street 2:SUITE 516
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3649
Mailing Address - Country:US
Mailing Address - Phone:305-403-2921
Mailing Address - Fax:305-403-2928
Practice Address - Street 1:6705 RED ROAD
Practice Address - Street 2:SUITE 516
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3649
Practice Address - Country:US
Practice Address - Phone:305-403-2921
Practice Address - Fax:305-403-2928
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant