Provider Demographics
NPI:1518523539
Name:RODRIGUEZ CAMEJO, LISETTE P (MD)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:P
Last Name:RODRIGUEZ CAMEJO
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:PO BOX 749112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-7019
Practice Address - Country:US
Practice Address - Phone:434-243-9466
Practice Address - Fax:434-243-9499
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2024-08-26
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-28
Provider Licenses
StateLicense IDTaxonomies
VA0101283237207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine