Healthcare Provider Details

I. General information

NPI: 1235374265
Provider Name (Legal Business Name): CHRIS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 KIDDER AVE
FAIRFIELD CA
94533-3919
US

IV. Provider business mailing address

1945 KIDDER AVE
FAIRFIELD CA
94533-3919
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-1777
  • Fax: 707-558-1770
Mailing address:
  • Phone: 707-558-1777
  • Fax: 707-558-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: