Healthcare Provider Details

I. General information

NPI: 1659290088
Provider Name (Legal Business Name): DASIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 W EMERALD ST STE 172
BOISE ID
83704-4828
US

IV. Provider business mailing address

517 PRINCE AVE
WILDER ID
83676-6010
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-3865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: