Healthcare Provider Details

I. General information

NPI: 1205700481
Provider Name (Legal Business Name): ISAAC RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S HUNTINGTON ST
SULPHUR LA
70663-4419
US

IV. Provider business mailing address

4411 SOMERSET ST
LAKE CHARLES LA
70605-3933
US

V. Phone/Fax

Practice location:
  • Phone: 337-429-8088
  • Fax: 337-347-6294
Mailing address:
  • Phone:
  • Fax: 337-347-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number213648
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: