Provider Demographics
NPI:1225221641
Name:RODRIGUEZ CARRANZA, LIDIA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:PATRICIA
Last Name:RODRIGUEZ CARRANZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:PATRICIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:2823 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1324
Practice Address - Country:US
Practice Address - Phone:559-499-6500
Practice Address - Fax:559-499-6411
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94807207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94807OtherCA LICENSE
CA00A948070Medicaid
CAA94807OtherCA LICENSE