Healthcare Provider Details

I. General information

NPI: 1487382693
Provider Name (Legal Business Name): BIANCA ISABEL RODRIGUEZ-GIBBONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CHADBOURNE RD
FAIRFIELD CA
94534-9656
US

IV. Provider business mailing address

520 CHADBOURNE RD
FAIRFIELD CA
94534-9656
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-3652
  • Fax:
Mailing address:
  • Phone: 707-366-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: