Provider Demographics
NPI:1508129305
Name:RODRIGUEZ, SELENE G
Entity Type:Individual
Prefix:MISS
First Name:SELENE
Middle Name:G
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SELENE
Other - Middle Name:G
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:981 WHITNEY RANCH DR
Mailing Address - Street 2:APT. 422
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2566
Mailing Address - Country:US
Mailing Address - Phone:702-752-9253
Mailing Address - Fax:
Practice Address - Street 1:981 WHITNEY RANCH DR
Practice Address - Street 2:APT 422
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2566
Practice Address - Country:US
Practice Address - Phone:702-752-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst