Provider Demographics
NPI:1588879456
Name:RODRIGUEZ, MARIA DEL CARMEN (MS)
Entity type:Individual
Prefix:MRS
First Name:MARIA DEL
Middle Name:CARMEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MARIA DEL
Other - Middle Name:CARMEN
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1475 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5919
Mailing Address - Country:US
Mailing Address - Phone:619-263-2823
Mailing Address - Fax:
Practice Address - Street 1:4350 OTAY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1617
Practice Address - Country:US
Practice Address - Phone:619-428-4476
Practice Address - Fax:619-428-6473
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool