Healthcare Provider Details

I. General information

NPI: 1669527396
Provider Name (Legal Business Name): MRS. KATHY RODRIGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CONDOR ST
EAST BOSTON MA
02128-1305
US

IV. Provider business mailing address

10 OVERLOOK RIDGE DR SUITE 423
MALDEN MA
02148-4711
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-6560
  • Fax: 617-569-1856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: