Provider Demographics
NPI:1043823446
Name:RODRIGUEZ EVANGELISTA, ROSA SARAITH (RADT-I)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:SARAITH
Last Name:RODRIGUEZ EVANGELISTA
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MAXWELL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9638
Mailing Address - Country:US
Mailing Address - Phone:707-880-6397
Mailing Address - Fax:
Practice Address - Street 1:2100 NAPA VALLEJO HWY BLDG M1M2
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-255-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
CA390200000X
CAR1403560820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251K00000XAgenciesPublic Health or Welfare
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program