Individual
MRS. CRISTINA MATA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4115 E LANCASTER AVE, FORT WORTH, TX 76103-3614
(817) 796-7370
Mailing address
PO BOX 4449, MCALLEN, TX 78502-4449
(956) 362-8460
(956) 362-8455
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA11311
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA11311
TEXAS MEDICAL BOARD LICENSE
TX
Enumeration date
08/08/2017
Last updated
07/13/2020
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