Healthcare Provider Details

I. General information

NPI: 1508347543
Provider Name (Legal Business Name): KAYLA MARIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BELLE TER
BAKERSFIELD CA
93307-3871
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-635-2950
  • Fax: 661-635-2983
Mailing address:
  • Phone: 661-635-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW122478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: