Provider Demographics
NPI:1013519883
Name:KING-RODRIGUEZ, LIGAYA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LIGAYA
Middle Name:
Last Name:KING-RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:LIGAYA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:449 CANAL ST APT 1811
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4385
Mailing Address - Country:US
Mailing Address - Phone:857-529-7529
Mailing Address - Fax:
Practice Address - Street 1:449 CANAL ST APT 1811
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-4385
Practice Address - Country:US
Practice Address - Phone:857-529-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty