Individual
NATASHA VICTORIA RODRIGUEZ MANCEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
711 W JOHN GWYNN AVE, PEORIA, IL 61605-2270
(309) 680-7600
(309) 671-2188
Mailing address
2214 N UNIVERSITY ST, PEORIA, IL 61604-3221
(309) 680-7669
(309) 681-8443
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007443
IL
Other
Enumeration date
12/02/2019
Last updated
12/02/2019
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