Healthcare Provider Details

I. General information

NPI: 1043122666
Provider Name (Legal Business Name): LIZANDRA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 UNIT 32 LOOP
VEGUITA NM
87062
US

IV. Provider business mailing address

PO BOX 585
VEGUITA NM
87062-0585
US

V. Phone/Fax

Practice location:
  • Phone: 575-842-9390
  • Fax:
Mailing address:
  • Phone: 575-842-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: