Provider Demographics
NPI:1194850164
Name:RODRIGUEZ, RAUL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20405 ANZA AVE APT 51
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7400
Mailing Address - Country:US
Mailing Address - Phone:310-259-1502
Mailing Address - Fax:
Practice Address - Street 1:20405 ANZA AVE APT 51
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7400
Practice Address - Country:US
Practice Address - Phone:310-259-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist