Provider Demographics
NPI:1700479219
Name:RODRIGUEZ, CRISTINA ISABEL (MSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ISABEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NEW YORK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5527
Mailing Address - Country:US
Mailing Address - Phone:386-327-5560
Mailing Address - Fax:
Practice Address - Street 1:120 E NEW YORK AVE STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5527
Practice Address - Country:US
Practice Address - Phone:386-327-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL174425Medicaid