Provider Demographics
NPI:1811543754
Name:RODRIGUEZ, RACHEL RENEE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
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 1:2796 PLUMAS ST APT 148
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4137
Mailing Address - Country:US
Mailing Address - Phone:559-908-1052
Mailing Address - Fax:
Practice Address - Street 1:1664 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0001
Practice Address - Country:US
Practice Address - Phone:775-682-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician