Provider Demographics
NPI:1871257394
Name:PRICE, BERNADETTE RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:RODRIGUEZ
Last Name:PRICE
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 1:2249 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-1764
Mailing Address - Country:US
Mailing Address - Phone:559-708-9259
Mailing Address - Fax:
Practice Address - Street 1:2249 ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-1764
Practice Address - Country:US
Practice Address - Phone:559-708-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-36506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst