Provider Demographics
NPI:1871790543
Name:RODRIGO, CHRISTOPHER L (MFT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:RODRIGO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30095 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3869
Mailing Address - Country:US
Mailing Address - Phone:951-676-5260
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DRIVE
Practice Address - Street 2:BLDG 100, SUITE 103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 35317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist