Provider Demographics
NPI:1497313845
Name:RODRIGUEZ, BRYAN DANIEL
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DANIEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 RUMRILL BLVD TRLR 11
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-4663
Mailing Address - Country:US
Mailing Address - Phone:510-837-1215
Mailing Address - Fax:
Practice Address - Street 1:1153 RUMRILL BLVD TRLR 11
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4663
Practice Address - Country:US
Practice Address - Phone:510-837-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst