Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003353400 |
---|---|
Provider Name | Barbara Rodriguez |
First Address | Ladera Ranch, CA 92694-1104 |
Second Address | Ladera Ranch, CA 92694-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2017 |
Last Update Date | 23/01/2017 |