Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003123241 |
---|---|
Provider Name | Ms. Maria Rodriguez |
First Address | Stockton, CA 95207-8251 |
Second Address | Stockton, CA 95207-8251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 13/06/2019 |