Individual
BRIAN AZAEL BACAN RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 SE NIGHTHAWK PL, SHELTON, WA 98584-7602
(850) 774-5850
Mailing address
221 SE NIGHTHAWK PL, SHELTON, WA 98584-7602
(850) 774-5850
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
WA
Other
Enumeration date
09/08/2023
Last updated
09/08/2023
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