Provider Demographics
NPI:1013376847
Name:RODRIGUEZ, ELIANA
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SPRING RD
Mailing Address - Street 2:BUILDING B SUITE 201
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1298
Mailing Address - Country:US
Mailing Address - Phone:805-485-6114
Mailing Address - Fax:805-532-1855
Practice Address - Street 1:612 SPRING RD
Practice Address - Street 2:BUILDING B SUITE 201
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1298
Practice Address - Country:US
Practice Address - Phone:805-485-6114
Practice Address - Fax:805-532-1855
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health