Provider Demographics
NPI:1568612042
Name:RODRIGUEZ, GENARO A (MFT REGISTERED)
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MFT REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SOUTH LAFAYETTE PARK PLACE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:520 SOUTH LAFAYETTE PARK PLACE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF61956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist