Basic Information
| Provider Information | |||||||||
| NPI: | 1255647236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ RODARTE | ||||||||
| FirstName: | ADELA | ||||||||
| MiddleName: | LISSETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 EAST 12TH STREET SUITE 259 | ||||||||
| Address2: | WESTCOAST CHILDRENS CLINIC | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 EAST 12TH STREET SUITE 259 | ||||||||
| Address2: | WESTCOAST CHILDRENS CLINIC | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101Y00000X | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.