Provider Demographics
NPI:1598515017
Name:RODRIGUEZ GUTIERREZ, LISNEY
Entity Type:Individual
Prefix:
First Name:LISNEY
Middle Name:
Last Name:RODRIGUEZ GUTIERREZ
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 1:1072 NE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4695
Mailing Address - Country:US
Mailing Address - Phone:786-320-1071
Mailing Address - Fax:
Practice Address - Street 1:1072 NE 17TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4695
Practice Address - Country:US
Practice Address - Phone:786-320-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9416306163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical