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General NPI Number Information
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NPI Number | 1184017329
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Entity Type | Individual
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Provider Name | TARA RODRIGUEZ IMF
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Gender | Female
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 901 N PACIFIC COAST HWY SUITE 200A
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2162
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Country | US
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Telephone | 323-641-8026
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Fax |
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Provider Business Mailing Address
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Address Line | 4626 MARWOOD DR
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City | LOS ANGELES
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State | CA
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Zip | 90065-5127
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 74896
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License Number State | CA
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