Provider Demographics
NPI:1194418442
Name:RODRIGUEZ, LYDIA ELFIDA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELFIDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 NEARING AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1453
Mailing Address - Country:US
Mailing Address - Phone:419-279-1339
Mailing Address - Fax:
Practice Address - Street 1:5734 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2038
Practice Address - Country:US
Practice Address - Phone:141-946-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator