=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427054220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORRAINE RODRIGUEZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 04/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6879 SOUTHPOINT DR N
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-6179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-296-2441
-----------------------------------------------------
Fax | 904-821-3113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16568
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32245-6568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-472-2300
-----------------------------------------------------
Fax | 904-472-2330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | ME73604
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | ME73604
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------