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:HC 57 BOX 11073
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 92
Practice Address - Street 2:BO. MEMBRILLO
Practice Address - City:CAMUY
Practice Address - State:PA
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-222-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR166171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical