Provider Demographics
NPI:1558958629
Name:RODRIGUEZ, LOURDES MARIA
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 W 56TH ST APT 1122
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6905
Mailing Address - Country:US
Mailing Address - Phone:786-514-9597
Mailing Address - Fax:
Practice Address - Street 1:1990 W 56TH ST APT 1122
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6905
Practice Address - Country:US
Practice Address - Phone:786-514-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator