Basic Information
| Provider Information | |||||||||
| NPI: | 1316134562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUES | ||||||||
| FirstName: | REGINA-MARIE | ||||||||
| MiddleName: | BIAGINI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17595 VIERRA CANYON RD # 420 | ||||||||
| Address2: | |||||||||
| City: | PRUNEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939073312 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 VICENTE ST | ||||||||
| Address2: | EDGEWOOD CENTER FOR CHILDREN AND FAMILIES | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156823211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.