Individual
RODRIGO DIAZ DE LOS REYES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
388 FINSBURY ST, LAFAYETTE, IN 47905-8938
(765) 507-1092
Mailing address
388 FINSBURY ST, LAFAYETTE, IN 47905-8938
(765) 507-1092
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/26/2023
Last updated
07/26/2023
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