Provider Demographics
NPI:1609653104
Name:RODARTE, JESSICA ROXANA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROXANA
Last Name:RODARTE
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 1:13531 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-9600
Mailing Address - Country:US
Mailing Address - Phone:760-646-7066
Mailing Address - Fax:
Practice Address - Street 1:1790 W PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3112
Practice Address - Country:US
Practice Address - Phone:909-558-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist