Provider Demographics
NPI:1215077839
Name:RODRIGUEZ, JENNIFER MANDADO (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MANDADO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E MADISON ST
Mailing Address - Street 2:APT-C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1078
Mailing Address - Country:US
Mailing Address - Phone:502-548-7031
Mailing Address - Fax:
Practice Address - Street 1:805 E MADISON ST
Practice Address - Street 2:APT-C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1078
Practice Address - Country:US
Practice Address - Phone:502-548-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39985207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine