Provider Demographics
NPI:1871633446
Name:RODRIGUEZ, MARIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 CAMINO DEL RIO N
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5720
Mailing Address - Country:US
Mailing Address - Phone:619-729-6656
Mailing Address - Fax:619-528-2269
Practice Address - Street 1:3111 CAMINO DEL RIO N
Practice Address - Street 2:STE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5720
Practice Address - Country:US
Practice Address - Phone:619-729-6656
Practice Address - Fax:619-528-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical