MEDICARE: ISAAC RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	213648	LA

General Provider Information

NPI Number	:	1205700481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC RODRIGUEZ

Provider Business Mailing Address
First Line	:	4411 SOMERSET ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-3933
Country	:	US
Telephone Number	:
Fax Number	:	337-347-6294

Provider Business Practice Location Address
First Line	:	901 S HUNTINGTON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-4419
Country	:	US
Telephone Number	:	337-429-8088
Fax Number	:	337-347-6294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	12/18/2025

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Directions to “ ISAAC RODRIGUEZ ” Practice Location

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