Provider Demographics
NPI:1396993556
Name:RODRIGUEZ, ALBERTO (PA)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:728 MOLALLA AVE A B
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2799
Mailing Address - Country:US
Mailing Address - Phone:503-656-9030
Mailing Address - Fax:503-656-9026
Practice Address - Street 1:16821 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0499
Practice Address - Country:US
Practice Address - Phone:360-433-9580
Practice Address - Fax:866-824-5107
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL18188363A00000X
ORPA01439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant