Provider Demographics
NPI:1235843293
Name:RODRIGUEZ, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
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:PO BOX 90024
Mailing Address - Street 2:PMB #20460
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92232-9024
Mailing Address - Country:US
Mailing Address - Phone:619-942-6410
Mailing Address - Fax:
Practice Address - Street 1:1224 E CALLE DE ORO
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-1925
Practice Address - Country:US
Practice Address - Phone:619-942-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician