Basic Information
| Provider Information | |||||||||
| NPI: | 1740756782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 S MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512793222 | ||||||||
| FaxNumber: | 9512795222 | ||||||||
| Practice Location | |||||||||
| Address1: | 2275 S MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512793222 | ||||||||
| FaxNumber: | 9512795222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ASW84386 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.