Provider Demographics
NPI:1508972084
Name:RODRIGUEZ, ISABELLE A (PHD)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4721 PASO DEL PUMA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3076
Mailing Address - Country:US
Mailing Address - Phone:505-881-5178
Mailing Address - Fax:505-293-7593
Practice Address - Street 1:4425 JUAN TABO NE
Practice Address - Street 2:SUITE 207
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2687
Practice Address - Country:US
Practice Address - Phone:505-881-5178
Practice Address - Fax:505-293-7593
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0146101YP2500X
NM262285103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM103633OtherVALUE OPTIONS COMMERCIAL
NMVNM0243OtherVALUE OPTIONS VENDER #
NM201012180OtherPRESBYTERIAN
NMA002OtherTRICARE
NM201012180OtherPRESBYTERIAN