Healthcare Provider Details

I. General information

NPI: 1114623410
Provider Name (Legal Business Name): JULIA POMSUK RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E HUNTINGTON DR UNIT D
ARCADIA CA
91006-3285
US

IV. Provider business mailing address

11701 TEXAS AVE APT 103
LOS ANGELES CA
90025-1615
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax:
Mailing address:
  • Phone: 949-538-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: