Provider Demographics
NPI:1346222049
Name:RODRIGUEZ JIMENEZ, LIZA M (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:M
Last Name:RODRIGUEZ JIMENEZ
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 1:2355 STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4541
Mailing Address - Country:US
Mailing Address - Phone:267-971-6333
Mailing Address - Fax:
Practice Address - Street 1:500 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5554
Practice Address - Country:US
Practice Address - Phone:541-472-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425323207R00000X
NDPT12611208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011459180001Medicaid
PA1011459180003Medicaid
PA2347693000OtherBLUECROSS BLUESHIELD
PA1672808OtherHIGHMARK BLUE SHIELD
PA1011459180002Medicaid
PA1011459180001Medicaid
PA1672808OtherHIGHMARK BLUE SHIELD
PA2347693000OtherBLUECROSS BLUESHIELD