Provider Demographics
NPI:1932644663
Name:RODRIGUEZ, LESLIE DAINE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DAINE
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:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-0793
Mailing Address - Country:US
Mailing Address - Phone:915-667-7320
Mailing Address - Fax:
Practice Address - Street 1:7318 GILLETT ST
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-6421
Practice Address - Country:US
Practice Address - Phone:915-667-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care