Provider Demographics
NPI:1144787672
Name:RODRIGUEZ, LISSETTE R
Entity Type:Individual
Prefix:PROF
First Name:LISSETTE
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISSETTE
Other - Middle Name:R
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:712H MCDOUGALL CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7166
Mailing Address - Country:US
Mailing Address - Phone:787-423-6233
Mailing Address - Fax:
Practice Address - Street 1:712H MCDOUGALL CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7166
Practice Address - Country:US
Practice Address - Phone:787-423-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator