Provider Demographics
NPI:1619114527
Name:RODRIGUEZ, VICTORIA (ADDICTION COUNSELOR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ADDICTION COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3607
Mailing Address - Country:US
Mailing Address - Phone:818-823-0978
Mailing Address - Fax:323-759-3464
Practice Address - Street 1:614 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3607
Practice Address - Country:US
Practice Address - Phone:818-823-0978
Practice Address - Fax:323-759-3464
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)