Individual
NITCHELLE AIDEE RODRIGUEZ MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
208 STARR ST, MERCEDES, TX 78570-2734
(956) 514-1643
Mailing address
3004 S L ST APT 2, MCALLEN, TX 78503-1903
(956) 388-0443
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
PA15602
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA15602
LICENSE
TX
Enumeration date
04/20/2022
Last updated
04/20/2022
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