Provider Demographics
NPI:1942443106
Name:RODRIGUEZ, RAYMOND ALBERT (COUNSELOR/ADDICTION)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ALBERT
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:COUNSELOR/ADDICTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27938 PUEBLO CALLE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4506
Mailing Address - Country:US
Mailing Address - Phone:510-784-0629
Mailing Address - Fax:510-784-9194
Practice Address - Street 1:27938 PUEBLO CALLE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4506
Practice Address - Country:US
Practice Address - Phone:510-784-0629
Practice Address - Fax:510-784-9194
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC.A.T.C. 970251101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)