Healthcare Provider Details

I. General information

NPI: 1508849811
Provider Name (Legal Business Name): DIANA RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA RODRIGUEZ MD, MPH

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-584-8735
  • Fax:
Mailing address:
  • Phone: 617-414-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number156557
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number156557
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD0065072
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: