Basic Information
| Provider Information | |||||||||
| NPI: | 1265848410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | NANCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 674 GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922203810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512829528 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2275 S MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512791333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.