Healthcare Provider Details

I. General information

NPI: 1184279549
Provider Name (Legal Business Name): KATHLEEN JANELLE RODRIGUEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

IV. Provider business mailing address

11013 SWEET RIVER DR
BAKERSFIELD CA
93311-9114
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8300
  • Fax:
Mailing address:
  • Phone: 661-720-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: