Provider Demographics
NPI:1255647236
Name:HERNANDEZ RODARTE, ADELA LISSETTE
Entity type:Individual
Prefix:MRS
First Name:ADELA
Middle Name:LISSETTE
Last Name:HERNANDEZ RODARTE
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 1:3301 EAST 12TH STREET SUITE 259
Mailing Address - Street 2:WESTCOAST CHILDRENS CLINIC
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601
Mailing Address - Country:US
Mailing Address - Phone:510-269-9030
Mailing Address - Fax:510-269-9031
Practice Address - Street 1:3301 EAST 12TH STREET SUITE 259
Practice Address - Street 2:WESTCOAST CHILDRENS CLINIC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-269-9030
Practice Address - Fax:510-269-9031
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor