Individual
MARTIN SETH RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1481 WINDSOR DR, SAN BERNARDINO, CA 92404-5416
(909) 361-6470
Mailing address
1729 S CONLON AVE, WEST COVINA, CA 91790-4402
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167G00000X
—
CA
Enumeration date
01/25/2019
Last updated
01/25/2019
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