Healthcare Provider Details

I. General information

NPI: 1861281107
Provider Name (Legal Business Name): HENRY RODRIGUEZ CATC III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18612 SANTA ANA AVE # 56
BLOOMINGTON CA
92316-2639
US

IV. Provider business mailing address

11492 TROTTER LN
FONTANA CA
92337-9037
US

V. Phone/Fax

Practice location:
  • Phone: 909-529-9213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: