Provider Demographics
NPI:1669294724
Name:RODRIGUEZ, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
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 1:791 S 4TH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3067
Mailing Address - Country:US
Mailing Address - Phone:928-920-6220
Mailing Address - Fax:928-259-7272
Practice Address - Street 1:791 S 4TH AVE STE E
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3067
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:928-259-7272
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician