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NPI Code Detail

MEDICARE: LIZETH KARINA RODRIGUEZ DIAZ

MEDICARE: LIZETH KARINA RODRIGUEZ DIAZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1538851431
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZETH KARINA RODRIGUEZ DIAZ
Provider Business Mailing Address
First Line : 3561 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1820
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3561 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1820
Country : US
Telephone Number : 503-437-1338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 05/22/2023

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