Provider Demographics
NPI:1336695089
Name:RODARTE, MARCIEL
Entity Type:Individual
Prefix:
First Name:MARCIEL
Middle Name:
Last Name:RODARTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 OCEAN ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6622
Mailing Address - Country:US
Mailing Address - Phone:831-459-0444
Mailing Address - Fax:
Practice Address - Street 1:542 OCEAN ST
Practice Address - Street 2:SUITE K
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6622
Practice Address - Country:US
Practice Address - Phone:831-459-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health