Provider Demographics
NPI:1225760994
Name:RODRIGUEZ, ANA MARIA
Entity Type:Individual
Prefix:
First Name:ANA MARIA
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 1:3636 N 1ST ST STE 123
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6818
Mailing Address - Country:US
Mailing Address - Phone:559-512-6802
Mailing Address - Fax:559-721-2038
Practice Address - Street 1:3636 N 1ST ST STE 123
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6818
Practice Address - Country:US
Practice Address - Phone:559-512-6802
Practice Address - Fax:559-721-2038
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
101Y00000X, 104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker