Provider Demographics
NPI:1851982755
Name:RODRIGUEZ, JENNIFER BETH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BETH
Other - Last Name:UPHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2697 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4519
Mailing Address - Country:US
Mailing Address - Phone:805-653-5045
Mailing Address - Fax:
Practice Address - Street 1:2697 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4519
Practice Address - Country:US
Practice Address - Phone:805-653-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health