Provider Demographics
NPI:1801677869
Name:RODRIGUEZ, JESLIAN LIZBET
Entity type:Individual
Prefix:
First Name:JESLIAN
Middle Name:LIZBET
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 1:1568 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4287
Mailing Address - Country:US
Mailing Address - Phone:787-550-1400
Mailing Address - Fax:
Practice Address - Street 1:1568 CRESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4287
Practice Address - Country:US
Practice Address - Phone:787-550-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty