Healthcare Provider Details

I. General information

NPI: 1699305292
Provider Name (Legal Business Name): CERINA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 S MARTIN L KING JR BLVD
FRESNO CA
93706-5345
US

IV. Provider business mailing address

4120 N BLYTHE AVE APT 106
FRESNO CA
93722-6391
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax:
Mailing address:
  • Phone: 559-728-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: