Healthcare Provider Details

I. General information

NPI: 1508121252
Provider Name (Legal Business Name): KRISTINA LAURA RODRIGUEZ PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 08/12/2026
Certification Date:
Deactivation Date: 12/20/2017
Reactivation Date: 08/12/2026

III. Provider practice location address

235 N MOORPARK RD
THOUSAND OAKS CA
91360-4311
US

IV. Provider business mailing address

235 N MOORPARK RD PO BOX 1454
THOUSAND OAKS CA
91360-4311
US

V. Phone/Fax

Practice location:
  • Phone: 805-338-3976
  • Fax:
Mailing address:
  • Phone: 805-338-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: