Provider Demographics
NPI:1417258575
Name:RODRIGUEZ, R JESSICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:JESSICA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:JESSICA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 3574
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95611-3574
Mailing Address - Country:US
Mailing Address - Phone:916-529-2343
Mailing Address - Fax:
Practice Address - Street 1:5344 MARCONI AVE APT 252
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4370
Practice Address - Country:US
Practice Address - Phone:916-529-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6933101YA0400X
CALS00050318101YM0800X
CAR1007060952101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)