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General NPI Number Information
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NPI Number | 1144924275
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Entity Type | Individual
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Provider Name | JESSICA VANESSA RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 39159 PASEO PADRE PKWY STE 121
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City | FREMONT
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State | CA
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Zip | 94538-1600
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Country | US
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Telephone | 510-952-1190
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Fax | 510-972-5976
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Provider Business Mailing Address
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Address Line | 39159 PASEO PADRE PKWY STE 121
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City | FREMONT
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State | CA
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Zip | 94538-1600
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Country | US
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Telephone | 510-952-1190
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Fax | 510-972-5976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC18518
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License Number State | CA
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