MEDICARE: DEBORAH RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	102391	CA

General Provider Information

NPI Number	:	1083953830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RODRIGUEZ

Provider Business Mailing Address
First Line	:	27261 LAS RAMBLAS STE 220
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6468
Country	:	US
Telephone Number	:	909-202-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 W FOOTHILL BLVD
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-8007
Country	:	US
Telephone Number	:	909-202-9982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	08/12/2020

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