Basic Information
| Provider Information | |||||||||
| NPI: | 1346222049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ-JIMENEZ | ||||||||
| FirstName: | LIZA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 S COLUMBUS BLVD APT 414 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191473508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157079403 | ||||||||
| FaxNumber: | 2157079898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 W ONTARIO ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157079403 | ||||||||
| FaxNumber: | 2157079898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD425323 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | PT12611 | ND | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1011459180002 | 05 | PA | MEDICAID | 1011459180003 | 05 | PA | MEDICAID | 2347693000 | 01 | PA | BLUECROSS BLUESHIELD | OTHER | 1011459180001 | 05 | PA | MEDICAID | 1672808 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |