Provider Demographics
NPI:1922357458
Name:RODRIGUEZ, MAYRA (MS)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2025
Mailing Address - Country:US
Mailing Address - Phone:646-236-8431
Mailing Address - Fax:
Practice Address - Street 1:4131 BOYD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2025
Practice Address - Country:US
Practice Address - Phone:646-236-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist