Provider Demographics
NPI:1780076455
Name:RODRIGUEZ, ANGELINA MERCEDES
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MERCEDES
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 1:608 W 189TH ST
Mailing Address - Street 2:APT. 42-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4207
Mailing Address - Country:US
Mailing Address - Phone:646-750-4105
Mailing Address - Fax:
Practice Address - Street 1:608 W 189TH ST
Practice Address - Street 2:APT. 42-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4207
Practice Address - Country:US
Practice Address - Phone:646-750-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692321252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency