Active NPI
Tina Dolores Rodriguez
- Marriage & Family Therapist
- Fresno, CA
National Provider Identifier
1255988655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT105453
- Practice address
- 693 W Bullard Ave
Fresno, CA 93704-1607 - Phone
- (559) 425-6885
- NPI assigned
- Aug 20, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT105453 | CA | Primary |
Addresses
Primary practice location
693 W Bullard Ave
Fresno, CA 93704-1607
Mailing address
255 N Fulton St Ste 105
Fresno, CA 93701-1600
Other practice location 1
255 N Fulton St Ste 105
Fresno, CA 93701-1600
Phone (559) 497-5056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT105453 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fresh Start Youth Center Incorporated | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Fresno, CA
- NPI 1699226803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671580800000",
"number": "1255988655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 N FULTON ST STE 105",
"city": "FRESNO",
"state": "CA",
"postal_code": "937011600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "693 W BULLARD AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937041607",
"telephone_number": "559-425-6885"
}
],
"practiceLocations": [
{
"address_1": "255 N Fulton St Ste 105",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937011600",
"country_code": "US",
"telephone_number": "559-497-5056",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "TINA",
"middle_name": "DOLORES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-20",
"last_updated": "2022-12-21",
"certification_date": "2022-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT105453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.