1386779833 NPI number — MS. EMERITA BANUELOS RODRIGUEZ LCSW

Table of content: MS. EMERITA BANUELOS RODRIGUEZ LCSW (NPI 1386779833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386779833 NPI number — MS. EMERITA BANUELOS RODRIGUEZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANUELOS RODRIGUEZ
Provider First Name:
EMERITA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386779833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1799 ESPLANADE WAY
Provider Second Line Business Mailing Address:
1965 LIVE OAK BLVD.
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95993-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-415-1874
Provider Business Mailing Address Fax Number:
530-671-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1799 ESPLANADE WAY
Provider Second Line Business Practice Location Address:
1965 LIVE OAK BLVD.
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95993-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-415-1874
Provider Business Practice Location Address Fax Number:
530-671-0943
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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