Individual
DR. MICHAEL ANTHONY RODEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
375 LAGUNA HONDA BLVD, LAGUNA HONDA HOSPITAL AND REHAB CENTER, MEDICAL SVCS, SAN FRANCISCO, CA 94116-1411
(415) 759-4561
(415) 759-4587
Mailing address
375 LAGUNA HONDA BLVD, LAGUNA HONDA HOSPITAL AND REHAB CENTER, MEDICAL SVCS, SAN FRANCISCO, CA 94116-1411
(415) 759-2300
(415) 759-2374
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY14238
CA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PSY14238
CA
103TB0200X
Cognitive & Behavioral Psychologist
PSY14238
CA
103TC0700X
Clinical Psychologist
PSY14238
CA
103TH0100X
Health Service Psychologist
PSY14238
CA
103TR0400X
Rehabilitation Psychologist
PSY14238
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY14238
—
CA
Enumeration date
02/07/2007
Last updated
11/01/2011
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