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NPI Code Detail

MEDICARE: PRICILLA RODARTE

MEDICARE: PRICILLA RODARTE
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
1171M00000XCase Manager/Care Coordinator
2101YA0400XAddiction (Substance Use Disorder) Counselor15198CA
3106S00000XBehavior Technician

General Provider Information

NPI Number : 1225609266
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRICILLA RODARTE
Provider Business Mailing Address
First Line : 5610 W DONNER AVE
Second Line :
City : FRESNO
State : CA
Zip : 93722-3721
Country : US
Telephone Number : 559-313-9701
Fax Number :
Provider Business Practice Location Address
First Line : 5610 W DONNER AVE
Second Line :
City : FRESNO
State : CA
Zip : 93722-3721
Country : US
Telephone Number : 559-313-9701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2021
Last Update Date : 05/14/2024

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Directions to “ PRICILLA RODARTE ” Practice Location

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