Healthcare Provider Details

I. General information

NPI: 1316637549
Provider Name (Legal Business Name): MARIA E RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 07/10/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MAIN ST
ROSEVILLE CA
95678-2232
US

IV. Provider business mailing address

124 MAIN ST
ROSEVILLE CA
95678-2232
US

V. Phone/Fax

Practice location:
  • Phone: 916-774-6802
  • Fax:
Mailing address:
  • Phone: 916-774-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: