Provider Demographics
NPI:1639410681
Name:RODRIGUEZ, ALVINA ANTONETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ALVINA
Middle Name:ANTONETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ALVINA
Other - Middle Name:ANTONETTE
Other - Last Name:MOJARRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3133 N MILLBROOK AVE STOP 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1425
Mailing Address - Country:US
Mailing Address - Phone:559-600-6790
Mailing Address - Fax:
Practice Address - Street 1:3133 N MILLBROOK AVE STOP 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1425
Practice Address - Country:US
Practice Address - Phone:559-600-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist