Individual
KEISHMARY RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 989-9499
Mailing address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 989-9499
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S54226893
DRIVERS LICENSE
MA
Enumeration date
04/29/2019
Last updated
04/29/2019
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