Provider Demographics
NPI:1962541698
Name:RODRIGUEZ, MAURICIO O
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:O
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 26TH AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1987
Mailing Address - Country:US
Mailing Address - Phone:415-533-2218
Mailing Address - Fax:
Practice Address - Street 1:439 26TH AVE
Practice Address - Street 2:APT. 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1987
Practice Address - Country:US
Practice Address - Phone:415-533-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAIMF83104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor