Provider Demographics
NPI:1659846004
Name:RODRIGUEZ, MARTHA MARIA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIA
Last Name:RODRIGUEZ
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 1:5185 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4623
Mailing Address - Country:US
Mailing Address - Phone:323-378-7534
Mailing Address - Fax:
Practice Address - Street 1:801 W SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3621
Practice Address - Country:US
Practice Address - Phone:626-541-0120
Practice Address - Fax:626-608-2624
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist