Provider Demographics
NPI:1396403671
Name:RODRIGUEZ CARRENO, ERNESTO (BACHELOR)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:
Last Name:RODRIGUEZ CARRENO
Suffix:
Gender:M
Credentials:BACHELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 HINMAN AVE.
Mailing Address - Street 2:D1
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202
Mailing Address - Country:US
Mailing Address - Phone:415-323-8057
Mailing Address - Fax:
Practice Address - Street 1:553 HINMAN AVE.
Practice Address - Street 2:D1
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:415-323-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician