Provider Demographics
NPI:1639877533
Name:RODRIGUEZ MARTINEZ, ESMERALDA
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:RODRIGUEZ MARTINEZ
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 1:29489 VIA LAS COLINAS APT 222
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2269
Mailing Address - Country:US
Mailing Address - Phone:918-710-0208
Mailing Address - Fax:
Practice Address - Street 1:31170 TEMECULA PKWY STE 202
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2915
Practice Address - Country:US
Practice Address - Phone:951-699-8640
Practice Address - Fax:951-225-4672
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY6085888106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician