Basic Information
| Provider Information | |||||||||
| NPI: | 1912180035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ GAZTAMBIDE | ||||||||
| FirstName: | BEATRIZ | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RODRIGUEZ | ||||||||
| OtherFirstName: | BEATRIZ | ||||||||
| OtherMiddleName: | MARIA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 10005 | ||||||||
| Address2: | ELM HEALTH GROUP, LLC | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356312005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567689509 | ||||||||
| FaxNumber: | 2567689715 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MARENGO ST | ||||||||
| Address2: | ELM HEALTH GROUP, LLC | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567689509 | ||||||||
| FaxNumber: | 2567689715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28474 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009913924 | 05 | AL | MEDICAID |