Provider Demographics
NPI:1083425698
Name:RODRIGUEZ, NATHALIE M (PSYD)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N MOLLISON AVE UNIT 50
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5520
Mailing Address - Country:US
Mailing Address - Phone:442-230-7669
Mailing Address - Fax:
Practice Address - Street 1:3405 KENYON ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5005
Practice Address - Country:US
Practice Address - Phone:619-630-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist