Individual
DANIELA IXMUCANE RODRIGUEZ-JAQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
77 CASA ST, SAN LUIS OBISPO, CA 93405-5803
(805) 269-1500
(805) 269-1585
Mailing address
2050 S BLOSSER RD, SANTA MARIA, CA 93458-7310
(805) 361-8030
(805) 361-8097
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
56719
CA
Other
Enumeration date
06/12/2019
Last updated
05/14/2024
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