Provider Demographics
NPI:1487293791
Name:RODRIGUEZ, ITZELI ESMERALDA
Entity type:Individual
Prefix:
First Name:ITZELI
Middle Name:ESMERALDA
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 1:350 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3959
Mailing Address - Country:US
Mailing Address - Phone:509-301-7388
Mailing Address - Fax:
Practice Address - Street 1:3808 S ANGELINE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1712
Practice Address - Country:US
Practice Address - Phone:509-301-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor