Provider Demographics
NPI:1689977514
Name:BURGOYNE, RODNEY WILLIAM
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:WILLIAM
Last Name:BURGOYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 S ARROYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2458
Mailing Address - Country:US
Mailing Address - Phone:626-799-8702
Mailing Address - Fax:626-799-1028
Practice Address - Street 1:774 S ARROYO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2458
Practice Address - Country:US
Practice Address - Phone:626-799-8702
Practice Address - Fax:626-799-1028
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4828102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst