Provider Demographics
NPI:1760045090
Name:JUAREZ-RODRIGUEZ, LISA ANN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:JUAREZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 TREYWAY LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4639
Mailing Address - Country:US
Mailing Address - Phone:361-739-8817
Mailing Address - Fax:
Practice Address - Street 1:3765 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1643
Practice Address - Country:US
Practice Address - Phone:361-773-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305534164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse