Healthcare Provider Details

I. General information

NPI: 1548117955
Provider Name (Legal Business Name): LIZZETTE RODRIGUEZ CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S SILVER AVE
DEMING NM
88030-4152
US

IV. Provider business mailing address

PO BOX 325
SILVER CITY NM
88062-0325
US

V. Phone/Fax

Practice location:
  • Phone: 575-936-4177
  • Fax: 575-936-4251
Mailing address:
  • Phone: 575-590-6197
  • Fax: 575-590-6079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberNA
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: