Healthcare Provider Details

I. General information

NPI: 1548633159
Provider Name (Legal Business Name): JANICE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 KIRKMAN ST
LAKE CHARLES LA
70607-3006
US

IV. Provider business mailing address

3608 KIRKMAN ST
LAKE CHARLES LA
70607-3006
US

V. Phone/Fax

Practice location:
  • Phone: 337-602-6302
  • Fax: 337-564-0931
Mailing address:
  • Phone: 337-602-6302
  • Fax: 337-564-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: