Provider Demographics
NPI:1487838843
Name:PENALOSA, RODERICK D (MA)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:D
Last Name:PENALOSA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 INTERNATIONAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606
Mailing Address - Country:US
Mailing Address - Phone:510-835-2777
Mailing Address - Fax:510-835-0164
Practice Address - Street 1:255 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2235
Practice Address - Country:US
Practice Address - Phone:510-835-2777
Practice Address - Fax:510-835-0164
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health