Mia Elana Roodhuyzen

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

121366 Issued in CA

Practice address

806 Vendola Dr
San Rafael, CA 94903-2941

Phone

(415) 686-1130

NPI assigned

Jul 11, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1043662380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 VENDOLA DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032941",
            "telephone_number": "415-686-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 VENDOLA DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032941",
            "telephone_number": "415-686-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROODHUYZEN",
        "first_name": "MIA",
        "middle_name": "ELANA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-11",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "121366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irene P Romano, PHARMD
• Mikelle Monique Romo, OTR/L
• Ron Andrews Medical Co
• Crystal Shauna Roncancio
• Rama Ronen, PH.D
• Susan Patricia Rook-Thomas, LMFT
• Penny S Roper
• Angelica Roque
• Aneissa Marie Rosas-Sanchez, MSW
• Rosebay Behavioral Health

• Marriage & Family Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.