Healthcare Provider Details

I. General information

NPI: 1952776254
Provider Name (Legal Business Name): ALMA ROSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

IV. Provider business mailing address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

V. Phone/Fax

Practice location:
  • Phone: 707-621-2562
  • Fax:
Mailing address:
  • Phone: 707-621-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112290
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: