Healthcare Provider Details

I. General information

NPI: 1982387288
Provider Name (Legal Business Name): JORDIN RODRIGUEZ AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 MENLO AVE
CLOVIS CA
93611-6145
US

IV. Provider business mailing address

1990 MENLO AVE
CLOVIS CA
93611-6145
US

V. Phone/Fax

Practice location:
  • Phone: 559-706-1622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT139673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: