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General NPI Number Information
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NPI Number | 1598294514
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Entity Type | Organization
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Legal Business Name | WELLNESS WITHIN
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 2202 25TH AVE STE B
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City | GULFPORT
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State | MS
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Zip | 39501-4520
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Country | US
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Telephone | 228-206-6843
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Fax | 228-206-6843
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Provider Business Mailing Address
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Address Line | PO BOX 253
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City | GULFPORT
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State | MS
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Zip | 39502-0253
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Country | US
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Telephone | 228-206-6843
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Fax | 228-357-9366
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Authorized Official
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Title or Position | PHYSICIAN & OWNER
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Name | DR. LIANA RODRIGUEZ
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Credential | D.O.
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Telephone | 228-206-6843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23342
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License Number State | MS
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