Healthcare Provider Details

I. General information

NPI: 1689077752
Provider Name (Legal Business Name): MIGUEL RODRIGUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 BOSWELLIA DR
BAKERSFIELD CA
93311-2648
US

IV. Provider business mailing address

4010 BOSWELLIA DR
BAKERSFIELD CA
93311-2648
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-2711
  • Fax:
Mailing address:
  • Phone: 949-500-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: