Healthcare Provider Details

I. General information

NPI: 1124957378
Provider Name (Legal Business Name): DERON DAVID RODRIGUEZ MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 AZTEC WAY
ANTELOPE CA
95843-4486
US

IV. Provider business mailing address

PO BOX 269003
SACRAMENTO CA
95826-9003
US

V. Phone/Fax

Practice location:
  • Phone: 916-338-6470
  • Fax: 916-338-6472
Mailing address:
  • Phone: 916-709-5585
  • Fax: 916-566-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP12106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: