Provider Demographics
NPI:1164555496
Name:RODRIGUEZ, AMADITA (CAS)
Entity Type:Individual
Prefix:MR
First Name:AMADITA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 DUCK BLIND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360
Mailing Address - Country:US
Mailing Address - Phone:209-862-2833
Mailing Address - Fax:
Practice Address - Street 1:1272 DUCK BLIND CIR
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1737
Practice Address - Country:US
Practice Address - Phone:209-862-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)