Provider Demographics
NPI:1669660882
Name:RODRIGUEZ, RYAN MICHAEL (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E REDD RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7275
Mailing Address - Country:US
Mailing Address - Phone:915-581-0712
Mailing Address - Fax:915-533-8680
Practice Address - Street 1:820 E REDD RD BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7275
Practice Address - Country:US
Practice Address - Phone:915-581-0712
Practice Address - Fax:915-581-0712
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60229753363A00000X
TXPA15056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA15056OtherTEXAS MEDICAL LICENSE