Provider Demographics
NPI:1215008420
Name:RODRIGUEZ, LEALANI (MD)
Entity Type:Individual
Prefix:
First Name:LEALANI
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-268-2239
Mailing Address - Fax:203-268-9143
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE 107 B
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-268-2239
Practice Address - Fax:203-268-9143
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53922207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02832135Medicaid
NYA4000654226Medicare PIN