Provider Demographics
NPI:1689845513
Name:RODRIGUEZ, YOLANDA BANUELOS
Entity Type:Individual
Prefix:MISS
First Name:YOLANDA
Middle Name:BANUELOS
Last Name:RODRIGUEZ
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 1:1040 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4322
Mailing Address - Country:US
Mailing Address - Phone:805-551-3131
Mailing Address - Fax:
Practice Address - Street 1:1040 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4322
Practice Address - Country:US
Practice Address - Phone:805-551-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist