Healthcare Provider Details

I. General information

NPI: 1790313773
Provider Name (Legal Business Name): DONNA C RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ STE 148
PACIFICA CA
94044-2686
US

IV. Provider business mailing address

80 EUREKA SQ STE 148
PACIFICA CA
94044-2686
US

V. Phone/Fax

Practice location:
  • Phone: 650-549-4638
  • Fax:
Mailing address:
  • Phone: 650-438-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC1703
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT47277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: