Provider Demographics
NPI:1902960446
Name:BROSIUS-RODRIGUEZ, KRISTINA
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:BROSIUS-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 VANTIS DR UNIT 6021
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2547
Mailing Address - Country:US
Mailing Address - Phone:714-812-1916
Mailing Address - Fax:949-305-8286
Practice Address - Street 1:30011 IVY GLENN DR STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5041
Practice Address - Country:US
Practice Address - Phone:714-812-1916
Practice Address - Fax:949-305-8286
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist