Provider Demographics
NPI:1477714624
Name:RODRIGUEZ GONZALEZ, YRIDIANA (MS)
Entity Type:Individual
Prefix:MISS
First Name:YRIDIANA
Middle Name:
Last Name:RODRIGUEZ GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 CANYON CREST DR STE 223
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6015
Mailing Address - Country:US
Mailing Address - Phone:909-223-6478
Mailing Address - Fax:
Practice Address - Street 1:5255 CANYON CREST DRIVE BLD 100
Practice Address - Street 2:STE 103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist