Individual
JOHANNA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1791 WALTON AVE, 3B, BRONX, NY 10453-8138
(718) 304-4139
Mailing address
1791 WALTON AVE, 3B, BRONX, NY 10453-8138
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
1103183
NY
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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