Provider Demographics
NPI:1508003047
Name:RODRIGUEZ, MARTINA MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9637 ARROW RTE
Mailing Address - Street 2:BUILDING #4, SUITE A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4553
Mailing Address - Country:US
Mailing Address - Phone:909-945-8894
Mailing Address - Fax:
Practice Address - Street 1:9637 ARROW RTE
Practice Address - Street 2:BUILDING #4, SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4553
Practice Address - Country:US
Practice Address - Phone:909-945-8894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist