Provider Demographics
NPI:1699308676
Name:RODRIGUEZ, MAURICIO XAVIER (PA)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:XAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 W ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3506
Mailing Address - Country:US
Mailing Address - Phone:956-544-5700
Mailing Address - Fax:956-350-9573
Practice Address - Street 1:3125 W ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3506
Practice Address - Country:US
Practice Address - Phone:956-544-5700
Practice Address - Fax:956-350-9573
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine