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General NPI Number Information
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NPI Number | 1417103755
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Entity Type | Individual
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Provider Name | LUIS JAVIER RODRIGUEZ MFT
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 2830 I ST SUITE 301
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City | SACRAMENTO
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State | CA
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Zip | 95816-4311
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Country | US
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Telephone | 916-509-2778
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Fax | 209-745-6626
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Provider Business Mailing Address
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Address Line | PO BOX 233
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City | GALT
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State | CA
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Zip | 95632-0233
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Country | US
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Telephone | 916-509-2778
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Fax | 209-745-6626
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC52744
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License Number State | CA
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