Provider Demographics
NPI:1649522640
Name:RODRIGUEZ, WENDY (RRW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E HARVARD ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1114
Mailing Address - Country:US
Mailing Address - Phone:818-551-0026
Mailing Address - Fax:818-551-0027
Practice Address - Street 1:501 E HARVARD ST
Practice Address - Street 2:UNIT A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1114
Practice Address - Country:US
Practice Address - Phone:818-551-0026
Practice Address - Fax:818-551-0027
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)