Provider Demographics
NPI:1124694617
Name:RODRIGUEZ, LAURA ADRIANA (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ADRIANA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 SW CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-6932
Mailing Address - Country:US
Mailing Address - Phone:863-231-2244
Mailing Address - Fax:
Practice Address - Street 1:2909 N ORANGE AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4639
Practice Address - Country:US
Practice Address - Phone:407-244-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4247171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist