Provider Demographics
NPI:1043608490
Name:RODRIGUEZ, TIARA (PSYD)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 WILSHIRE BLVD
Mailing Address - Street 2:SUITE NUMBER 510
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3808
Mailing Address - Country:US
Mailing Address - Phone:562-904-3999
Mailing Address - Fax:855-688-6746
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:SUITE NUMBER 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3808
Practice Address - Country:US
Practice Address - Phone:562-904-3999
Practice Address - Fax:855-688-6746
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical