Provider Demographics
NPI:1780466896
Name:RODRIGUEZ HERNANDEZ, LISANDY
Entity type:Individual
Prefix:DR
First Name:LISANDY
Middle Name:
Last Name:RODRIGUEZ HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5212
Mailing Address - Country:US
Mailing Address - Phone:954-678-7123
Mailing Address - Fax:
Practice Address - Street 1:1510 SW 78TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5212
Practice Address - Country:US
Practice Address - Phone:954-678-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF08230269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily