Individual
DR. JACKIE VALESCA RODRIGUEZ BRONICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., MSC
Contact information
Practice address
1035 CAMBRIDGE ST, CAMBRIDGE, MA 02141-1057
(617) 286-4565
Mailing address
34 E NEWTON ST, BOSTON, MA 02118-1944
(617) 286-4565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
307533-01
NY
207R00000X
Internal Medicine Physician
TM109
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2015
Last updated
01/29/2021
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