Healthcare Provider Details

I. General information

NPI: 1700710076
Provider Name (Legal Business Name): JUAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

4765 HILLSDALE DR
LOS ANGELES CA
90032-1528
US

V. Phone/Fax

Practice location:
  • Phone: 626-759-9154
  • Fax:
Mailing address:
  • Phone: 213-245-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: