MEDICARE: LISETTE RODRIGUEZ 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)	11176605	FL

General Provider Information

NPI Number	:	1427462555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETTE RODRIGUEZ IBCLC

Provider Business Mailing Address
First Line	:	2106 NE 124TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2619
Country	:	US
Telephone Number	:	786-306-2082
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 NE 124TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2619
Country	:	US
Telephone Number	:	786-306-2082
Fax Number	:

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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