Provider Demographics
NPI:1558840108
Name:RODRIGUEZ, ISABELLA TERESA
Entity Type:Individual
Prefix:MS
First Name:ISABELLA
Middle Name:TERESA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7749
Mailing Address - Country:US
Mailing Address - Phone:305-450-7675
Mailing Address - Fax:
Practice Address - Street 1:2989 BROADMOOR VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4403
Practice Address - Country:US
Practice Address - Phone:719-434-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician