Provider Demographics
NPI:1740977339
Name:HERNANDEZ RODRIGUEZ, LEYDIS
Entity type:Individual
Prefix:
First Name:LEYDIS
Middle Name:
Last Name:HERNANDEZ 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 1:727 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5371
Mailing Address - Country:US
Mailing Address - Phone:239-308-2940
Mailing Address - Fax:
Practice Address - Street 1:727 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5371
Practice Address - Country:US
Practice Address - Phone:239-308-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL342000000X, 347E00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No342000000XTransportation ServicesTransportation Network Company
No347E00000XTransportation ServicesTransportation Broker