Healthcare Provider Details

I. General information

NPI: 1932120490
Provider Name (Legal Business Name): OLGA RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BICKFORD ST
JAMAICA PLAIN MA
02130-1401
US

IV. Provider business mailing address

357 ASHMONT ST
DORCHESTER CENTER MA
02124-3813
US

V. Phone/Fax

Practice location:
  • Phone: 617-971-2331
  • Fax:
Mailing address:
  • Phone: 617-265-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number215216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: