Provider Demographics
NPI:1457801516
Name:RODRIGUEZ, GLORIA MARIA (LMFT 118894)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMFT 118894
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:MARIA
Other - Last Name:MONDRAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT 95677
Mailing Address - Street 1:2105 E OCEAN BLVD UNIT 19
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2436
Mailing Address - Country:US
Mailing Address - Phone:323-236-3949
Mailing Address - Fax:
Practice Address - Street 1:8320 IOWA ST STE 201
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4928
Practice Address - Country:US
Practice Address - Phone:562-904-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist