Provider Demographics
NPI:1992836969
Name:RODRIGUEZ, XIOMARA PATRICIA
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:PATRICIA
Last Name:RODRIGUEZ
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 1:27261 LAS RAMBLAS
Mailing Address - Street 2:STE 220
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6441
Mailing Address - Country:US
Mailing Address - Phone:909-347-9269
Mailing Address - Fax:
Practice Address - Street 1:1461 E COOLEY DR
Practice Address - Street 2:STE 100
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3921
Practice Address - Country:US
Practice Address - Phone:909-347-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist