Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1316122914 |
---|---|
Provider Name | Anna Carolina Rodriguez |
First Address | Lake View Terrace, CA 91342-6506 |
Second Address | Lake View Terrace, CA 91342-6506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |