Provider Demographics
NPI:1003370479
Name:RODRIGUEZ, LISA (LVN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CEDRON CHASE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5254
Mailing Address - Country:US
Mailing Address - Phone:409-351-1938
Mailing Address - Fax:
Practice Address - Street 1:115 CEDRON CHASE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5254
Practice Address - Country:US
Practice Address - Phone:409-351-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347084164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse