Provider Demographics
NPI:1255568101
Name:RODRIGUEZ-WADE, BEATRIZ (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BEATRIZ
Middle Name:
Last Name:RODRIGUEZ-WADE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:BEA
Other - Middle Name:
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11654 SPRINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5022
Mailing Address - Country:US
Mailing Address - Phone:858-486-0685
Mailing Address - Fax:
Practice Address - Street 1:11654 SPRINGSIDE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5022
Practice Address - Country:US
Practice Address - Phone:858-486-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist