Provider Demographics
NPI:1073320875
Name:RODRIGUEZ, GAMALIEL E JR (MA)
Entity type:Individual
Prefix:
First Name:GAMALIEL
Middle Name:E
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-0951
Mailing Address - Country:US
Mailing Address - Phone:951-445-0638
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 951
Practice Address - Street 2:
Practice Address - City:HELENDALE
Practice Address - State:CA
Practice Address - Zip Code:92342-0951
Practice Address - Country:US
Practice Address - Phone:951-445-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling