Healthcare Provider Details

I. General information

NPI: 1437281003
Provider Name (Legal Business Name): MARISSA I RODRIGUEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W WALNUT AVE STE B
VISALIA CA
93277-6233
US

IV. Provider business mailing address

1750 W WALNUT AVE STE B
VISALIA CA
93277-6233
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1490
  • Fax: 559-732-7942
Mailing address:
  • Phone: 559-627-1490
  • Fax: 559-732-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: