Healthcare Provider Details

I. General information

NPI: 1699163055
Provider Name (Legal Business Name): RODRIGUEZ PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10613 N HAYDEN RD SUITE J-100
SCOTTSDALE AZ
85260-5683
US

IV. Provider business mailing address

10613 N HAYDEN RD SUITE J-100
SCOTTSDALE AZ
85260-5683
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-2855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4399
License Number StateAZ

VIII. Authorized Official

Name: SANDRA RODRIGUEZ-SIUTS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 210-296-5275