MEDICARE: LESLIE ANN 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	171M00000X	Case Manager/Care Coordinator
2	171M00000X	Case Manager/Care Coordinator	CBHCMS.0100545	FL

General Provider Information

NPI Number	:	1649162660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN RODRIGUEZ

Provider Business Mailing Address
First Line	:	3257 TORRENCE AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-7350
Country	:	US
Telephone Number	:	305-965-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4945 S ORANGE BLOSSOM TRL STE 6
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-2381
Country	:	US
Telephone Number	:	407-964-1440
Fax Number	:	321-226-5323

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

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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