Provider Demographics
NPI:1568068013
Name:RODRIGUEZ, JAEL STEPHANIE
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:STEPHANIE
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 1:969 S SANTA FE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6910
Mailing Address - Country:US
Mailing Address - Phone:760-315-2615
Mailing Address - Fax:
Practice Address - Street 1:969 S SANTA FE AVE STE C
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6910
Practice Address - Country:US
Practice Address - Phone:760-315-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No251S00000XAgenciesCommunity/Behavioral Health