Healthcare Provider Details

I. General information

NPI: 1508972084
Provider Name (Legal Business Name): ISABELLE A RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLE A RODRIGUEZ PHD

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 JUAN TABO NE SUITE 207
ALBUQUERQUE NM
87111-2687
US

IV. Provider business mailing address

4721 PASO DEL PUMA NE
ALBUQUERQUE NM
87111-3076
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-5178
  • Fax: 505-293-7593
Mailing address:
  • Phone: 505-881-5178
  • Fax: 505-293-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0146
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number262285
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number262285
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: