| NPI | 1275912164 |
|---|---|
| Former Name | JACKIE VALESCA RODRIGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 307533-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA TM109) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2021-01-29 |