Individual
LICENIA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3645 S MONTREAL PL, TUCSON, AZ 85730-3223
(520) 305-7861
Mailing address
3645 S MONTREAL PL, TUCSON, AZ 85730-3223
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
BH6821
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6821
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
06/21/2021
Last updated
06/21/2021
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