Healthcare Provider Details

I. General information

NPI: 1528835154
Provider Name (Legal Business Name): ROCIO B RODRIGUEZ LMFT DYNAMIC HEALTH AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OLD BAYSHORE HWY STE 123
BURLINGAME CA
94010-1506
US

IV. Provider business mailing address

1601 OLD BAYSHORE HWY STE 123
BURLINGAME CA
94010-1506
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-9005
  • Fax: 415-642-5477
Mailing address:
  • Phone: 415-939-9005
  • Fax: 415-642-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROCIO B RODRIGUEZ
Title or Position: OWNER
Credential: LMFT
Phone: 415-939-9005