Individual
MRS. CRISTINA MATA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
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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