Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME73604 | FL |
N | 207VX0000X | Obstetrician | ME73604 | FL |
NPI | 1427054220 |
---|---|
Provider Name | Lorraine Rodriguez |
First Address | Jacksonville, FL 32245-6568 |
Second Address | Jacksonville, FL 32216-6179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 01/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
253363400 | (05) | FL |
G63602 | (02) | FL |