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General NPI Number Information
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NPI Number | 1568153344
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Entity Type | Individual
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Provider Name | MARLAINA SHALISE RODRIGUEZ ACSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 600 A ST
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City | DAVIS
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State | CA
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Zip | 95616-3649
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Country | US
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Telephone | 530-204-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 4059 INNOVATOR DR UNIT 5101
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City | SACRAMENTO
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State | CA
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Zip | 95834-7917
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Country | US
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Telephone | 818-585-8168
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 113912
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License Number State | CA
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