Provider Demographics
NPI:1457643744
Name:RODRIGUEZ, LYDIA ANN
Entity Type:Individual
Prefix:
First Name:LYDIA ANN
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 1:343 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2903
Mailing Address - Country:US
Mailing Address - Phone:760-353-6151
Mailing Address - Fax:760-353-6152
Practice Address - Street 1:343 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2903
Practice Address - Country:US
Practice Address - Phone:760-353-6151
Practice Address - Fax:760-353-6152
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor