MEDICARE: LIZZETTE RODRIGUEZ CSW

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	172V00000X	Community Health Worker	NA	NM

General Provider Information

NPI Number	:	1548117955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZZETTE RODRIGUEZ CSW

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88062-0325
Country	:	US
Telephone Number	:	575-590-6197
Fax Number	:	575-590-6079

Provider Business Practice Location Address
First Line	:	416 S SILVER AVE
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-4152
Country	:	US
Telephone Number	:	575-936-4177
Fax Number	:	575-936-4251

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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