Provider Demographics
NPI:1184509713
Name:RODRIGUEZ-KLONCZ, CONSUELO
Entity type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:RODRIGUEZ-KLONCZ
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 1:101 E NICOLET ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5551
Mailing Address - Country:US
Mailing Address - Phone:951-922-0280
Mailing Address - Fax:
Practice Address - Street 1:101 E NICOLET ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5551
Practice Address - Country:US
Practice Address - Phone:951-922-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool