Provider Demographics
NPI:1245748532
Name:RODRIGUEZ, KEVIN BERNARD I (EXPERIENCE)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BERNARD
Last Name:RODRIGUEZ
Suffix:I
Gender:M
Credentials:EXPERIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3907
Mailing Address - Country:US
Mailing Address - Phone:718-676-9491
Mailing Address - Fax:
Practice Address - Street 1:391 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3907
Practice Address - Country:US
Practice Address - Phone:718-676-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator