Provider Demographics
NPI:1508664699
Name:RODRIGUEZ, MICHAEL D SR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:RODRIGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 GOLDEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2589
Mailing Address - Country:US
Mailing Address - Phone:760-696-8107
Mailing Address - Fax:
Practice Address - Street 1:1902 GOLDEN HILL DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2589
Practice Address - Country:US
Practice Address - Phone:760-696-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty