Provider Demographics
NPI:1356616767
Name:RODRIGUEZ, ELENA PATRICIA (PSYD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:PATRICIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33025 ROAD 159
Mailing Address - Street 2:
Mailing Address - City:IVANHOE
Mailing Address - State:CA
Mailing Address - Zip Code:93235-1234
Mailing Address - Country:US
Mailing Address - Phone:210-722-8054
Mailing Address - Fax:
Practice Address - Street 1:33025 ROAD 159
Practice Address - Street 2:
Practice Address - City:IVANHOE
Practice Address - State:CA
Practice Address - Zip Code:93235-1234
Practice Address - Country:US
Practice Address - Phone:210-722-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist