Healthcare Provider Details

I. General information

NPI: 1801616362
Provider Name (Legal Business Name): LISANDRA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S GOLDENROD RD
ORLANDO FL
32822-7902
US

IV. Provider business mailing address

2300 S GOLDENROD RD
ORLANDO FL
32822-7902
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-6361
  • Fax:
Mailing address:
  • Phone: 407-380-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberRPT115354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: