Provider Demographics
NPI:1124461173
Name:RODRIGUEZ, ALICIA CONSUELO
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CONSUELO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E CALIFORNIA BLVD
Mailing Address - Street 2:4
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:747 E CALIFORNIA BLVD
Practice Address - Street 2:4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3864
Practice Address - Country:US
Practice Address - Phone:303-775-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist