Provider Demographics
NPI:1568942480
Name:RODRIGUEZ MUJICA, IVONNE ARACELY (PA-C)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:ARACELY
Last Name:RODRIGUEZ MUJICA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IVONNE
Other - Middle Name:ARACELY
Other - Last Name:RODRIGUEZ MUJICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 901404
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-1404
Mailing Address - Country:US
Mailing Address - Phone:505-366-4193
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 901404
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84090-1404
Practice Address - Country:US
Practice Address - Phone:505-366-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9879378-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant