Provider Demographics
NPI:1992330542
Name:RODRIGUEZ, DAMIAN (PPS)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 MORRIS KYLE DR
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-9711
Mailing Address - Country:US
Mailing Address - Phone:559-659-2131
Mailing Address - Fax:
Practice Address - Street 1:1976 MORRIS KYLE DR
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-9711
Practice Address - Country:US
Practice Address - Phone:559-659-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool