Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013052091 |
---|---|
Provider Name | Diana Rodriguez |
First Address | San Jose, CA 95131-1888 |
Second Address | San Jose, CA 95131-1888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 05/03/2021 |