Basic Information
Provider Information
NPI: 1649840513
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: LILIANA
MiddleName: DENNISE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4344 BRATTON RD
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 784131980
CountryCode: US
TelephoneNumber: 9563347328
FaxNumber:  
Practice Location
Address1: 2230 SARATOGA BLVD
Address2:  
City: CORPUS CHRISTI
State: TX
PostalCode: 784173400
CountryCode: US
TelephoneNumber: 3618814788
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2021
LastUpdateDate: 03/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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