Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A94807 | CA |
N | 111NI0900X | Internist | A94807 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A94807 | CA |
NPI | 1225221641 |
---|---|
Provider Name | Lidia Patricia Rodriguez Carranza |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A948070 | (05) | CA |
A94807 | CA LICENSE (01) | CA |