Individual
IMMANUEL RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3742 W 4000 S, WEST HAVEN, UT 84401-9630
(801) 731-0426
Mailing address
391 W 4800 S, APT. 805, WASHINGTON TERRACE, UT 84405-6062
(951) 529-6768
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
01/31/2014
Last updated
01/31/2014
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