Provider Demographics
NPI:1124492988
Name:RODRIGUES, CAROL (MS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5558 CALIFORNIA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0706
Mailing Address - Country:US
Mailing Address - Phone:661-210-7647
Mailing Address - Fax:
Practice Address - Street 1:27200 TOURNEY RD
Practice Address - Street 2:#255
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4990
Practice Address - Country:US
Practice Address - Phone:661-222-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24440103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst