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General NPI Number Information
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NPI Number | 1508972084
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Entity Type | Individual
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Provider Name | ISABELLE A RODRIGUEZ PHD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 4425 JUAN TABO NE SUITE 207
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2687
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Country | US
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Telephone | 505-881-5178
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Fax | 505-293-7593
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Provider Business Mailing Address
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Address Line | 4721 PASO DEL PUMA NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3076
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Country | US
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Telephone | 505-881-5178
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Fax | 505-293-7593
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0146
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 262285
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 262285
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License Number State | NM
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