Provider Demographics
NPI:1518523539
Name:RODRIGUEZ, LISETTE PATRICIA (MD)
Entity Type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:PATRICIA
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 1:1240 LEE ST STE 2401
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0817
Mailing Address - Country:US
Mailing Address - Phone:434-243-6297
Mailing Address - Fax:424-244-9438
Practice Address - Street 1:1215 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0816
Practice Address - Country:US
Practice Address - Phone:434-924-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2022-07-04
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN29704390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program