Provider Demographics
NPI:1497892228
Name:RODRIGUEZ, NED WEYER (PHD)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:WEYER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 30TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3063
Mailing Address - Country:US
Mailing Address - Phone:310-989-5034
Mailing Address - Fax:310-452-1309
Practice Address - Street 1:2665 30TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3063
Practice Address - Country:US
Practice Address - Phone:310-989-5034
Practice Address - Fax:310-452-1309
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#16434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16434Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER