Provider Demographics
NPI:1639808710
Name:RODRIGUEZ VALLE, KEYLA MARIE
Entity Type:Individual
Prefix:
First Name:KEYLA
Middle Name:MARIE
Last Name:RODRIGUEZ VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-9133
Mailing Address - Fax:
Practice Address - Street 1:CARR 107 KM 2.3 BO BORINQUEN
Practice Address - Street 2:EDIFICIO PLAZA DEL MAR
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-641-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical