MEDICARE: JUANA MARIA RODRIGUEZ BS,IBCLC

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1346730181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA MARIA RODRIGUEZ BS,IBCLC

Provider Business Mailing Address
First Line	:	4539 SW 15TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6314
Country	:	US
Telephone Number	:	239-851-0909
Fax Number	:	866-229-4468

Provider Business Practice Location Address
First Line	:	4539 SW 15TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6314
Country	:	US
Telephone Number	:	239-851-0909
Fax Number	:	866-229-4468

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

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	05/17/2018

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