Individual
LISA M. RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 259-8700
(813) 259-8749
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME75890
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256862400
—
FL
01
—
47105
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/09/2006
Last updated
01/20/2015
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