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NPI Code Detail

MEDICARE: LIRKA GONZALEZ RODRIGUEZ

MEDICARE:   LIRKA  GONZALEZ RODRIGUEZ
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianME127374FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y0NQPOTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568802080
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIRKA GONZALEZ RODRIGUEZ
Provider Business Mailing Address
First Line : 3302 BONITA BEACH RD STE 170
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-4217
Country : US
Telephone Number : 239-624-1050
Fax Number : 239-624-1051
Provider Business Practice Location Address
First Line : 3302 BONITA BEACH RD STE 170
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34134-4217
Country : US
Telephone Number : 239-624-1050
Fax Number : 239-624-1051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2013
Last Update Date : 07/21/2022

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Directions to “ LIRKA GONZALEZ RODRIGUEZ ” Practice Location

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