Healthcare Provider Details

I. General information

NPI: 1356011175
Provider Name (Legal Business Name): LPR PROFESSIONAL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 NE VAN LOON LN
CAPE CORAL FL
33909-2798
US

IV. Provider business mailing address

1518 NE VAN LOON LN
CAPE CORAL FL
33909-2798
US

V. Phone/Fax

Practice location:
  • Phone: 786-597-4260
  • Fax:
Mailing address:
  • Phone: 786-597-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LILLIAM PEREZ RODRIGUEZ
Title or Position: APRN
Credential: APRN
Phone: 786-597-4260