Provider Demographics
NPI:1891024568
Name:RODRIGUEZ, JEANNE H (LOTR)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:H
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 CARMENERE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1110
Mailing Address - Country:US
Mailing Address - Phone:504-975-6634
Mailing Address - Fax:
Practice Address - Street 1:718 CARMENERE DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1110
Practice Address - Country:US
Practice Address - Phone:504-975-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist