Basic Information
| Provider Information | |||||||||
| NPI: | 1801333950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | LIZA | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 708 W SAINT PETER AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783843037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612964880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 E. RILEY ST. | ||||||||
| Address2: | |||||||||
| City: | FREER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613947311 | ||||||||
| FaxNumber: | 3613947158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2017 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP132827 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.