Healthcare Provider Details

I. General information

NPI: 1306843032
Provider Name (Legal Business Name): AUSTRIA LUBBETT RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15212 E COLONIAL DR
ORLANDO FL
32826-5518
US

IV. Provider business mailing address

15212 EAST COLONIAL DRIVE
ORLANDO FL
32826
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-1777
  • Fax: 407-380-1766
Mailing address:
  • Phone: 407-380-1777
  • Fax: 407-380-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: