Individual
TINA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(917) 767-9679
Mailing address
15711 14TH AVE, WHITESTONE, NY 11357-2709
(917) 767-9679
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
020064-1
NY
Other
Enumeration date
09/06/2016
Last updated
09/12/2022
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