Basic Information
| Provider Information | |||||||||
| NPI: | 1861577819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW60626 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1799 ESPLANADE WAY | ||||||||
| Address2: | N/A | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959931011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306710943 | ||||||||
| FaxNumber: | 5306710943 | ||||||||
| Practice Location | |||||||||
| Address1: | 1965 LIVE OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959918850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227200 | ||||||||
| FaxNumber: | 5308227108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW60626 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 10018 | 05 | CA | MEDICAID |