Healthcare Provider Details

I. General information

NPI: 1427462555
Provider Name (Legal Business Name): LISETTE RODRIGUEZ IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NE 124TH ST
NORTH MIAMI FL
33181-2619
US

IV. Provider business mailing address

2106 NE 124TH ST
NORTH MIAMI FL
33181-2619
US

V. Phone/Fax

Practice location:
  • Phone: 786-306-2082
  • Fax:
Mailing address:
  • Phone: 786-306-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11176605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: