Provider Demographics
NPI:1427713197
Name:RODRIGUEZ, GUADALUPE MARIBEL
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MARIBEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:MARIBEL
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28155 ENCANTO DR UNIT 1511
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-3250
Mailing Address - Country:US
Mailing Address - Phone:951-570-8455
Mailing Address - Fax:
Practice Address - Street 1:1111 E TAHQUITZ CANYON WAY STE 110
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-0113
Practice Address - Country:US
Practice Address - Phone:951-440-6220
Practice Address - Fax:951-244-5542
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst