Provider Demographics
NPI:1184449266
Name:RODRIGUEZ, ANDREA ALIDA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALIDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 COOK RIOLO RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9239
Mailing Address - Country:US
Mailing Address - Phone:279-209-6273
Mailing Address - Fax:
Practice Address - Street 1:1400 COLEMAN AVE STE E15-1
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4374
Practice Address - Country:US
Practice Address - Phone:408-244-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician