Provider Demographics
NPI:1841757267
Name:RODRIGUEZ, JESUS ABEL (AMFT158627)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ABEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:AMFT158627
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1666 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1346
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-662-4100
Practice Address - Street 1:1666 PRECISION PARK LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92173-1346
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-662-4100
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII051610324101YA0400X
CA158627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)