Individual
MICHELLE DETIVEAUX RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11315 IVY CADENCE, SAN ANTONIO, TX 78253-6260
(210) 724-7970
Mailing address
11315 IVY CADENCE, SAN ANTONIO, TX 78253-6260
(210) 724-7970
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
86676
TX
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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