Provider Demographics
NPI:1912180035
Name:RODRIGUEZ GAZTAMBIDE, BEATRIZ MARIA (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:MARIA
Last Name:RODRIGUEZ GAZTAMBIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEATRIZ
Other - Middle Name:MARIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10005
Mailing Address - Street 2:ELM HEALTH GROUP, LLC
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-768-9509
Mailing Address - Fax:256-768-9715
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:ELM HEALTH GROUP, LLC
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-768-9509
Practice Address - Fax:256-768-9715
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913924Medicaid
AL510I080104Medicare PIN