Healthcare Provider Details

I. General information

NPI: 1013758713
Provider Name (Legal Business Name): STEPHEN TORREZ RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

IV. Provider business mailing address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax:
Mailing address:
  • Phone: 714-732-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: