Provider Demographics
NPI:1962837583
Name:RODRIGUEZ, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RODRIGUEZ
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 1:620 BAYCHESTER AVE.
Mailing Address - Street 2:13 J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:646-337-5867
Mailing Address - Fax:
Practice Address - Street 1:620 BAYCHESTER AVE
Practice Address - Street 2:13 J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4402
Practice Address - Country:US
Practice Address - Phone:646-337-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1266127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist