MEDICARE: DR. KATHERINE RODRIGUEZ PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	21851	CA

General Provider Information

NPI Number	:	1184887010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE RODRIGUEZ PSY.D.

Provider Business Mailing Address
First Line	:	2423 CAMINO DEL RIO S
Second Line	:	SUITE #106
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3702
Country	:	US
Telephone Number	:	619-806-8069
Fax Number	:	858-565-6707

Provider Business Practice Location Address
First Line	:	2423 CAMINO DEL RIO S
Second Line	:	SUITE #106
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3702
Country	:	US
Telephone Number	:	619-806-8069
Fax Number	:	858-565-6707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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