Provider Demographics
NPI:1023489267
Name:RODRIGUEZ, LESLIE ANN (MED)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SENNA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2508
Mailing Address - Country:US
Mailing Address - Phone:407-375-1638
Mailing Address - Fax:
Practice Address - Street 1:3002 SENNA CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2508
Practice Address - Country:US
Practice Address - Phone:407-375-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003425200Medicaid