Provider Demographics
NPI:1811695588
Name:RODARTE, MICHELLE (RADT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RODARTE
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83912 AVENUE 45 STE 9
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3338
Mailing Address - Country:US
Mailing Address - Phone:951-955-1530
Mailing Address - Fax:
Practice Address - Street 1:83912 AVENUE 45
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-7351
Practice Address - Country:US
Practice Address - Phone:442-933-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1491471222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)