Healthcare Provider Details

I. General information

NPI: 1649966318
Provider Name (Legal Business Name): LETICIA I RODRIGUEZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

4450 GROVES PL
SOMIS CA
93066-9771
US

V. Phone/Fax

Practice location:
  • Phone: 805-366-4040
  • Fax:
Mailing address:
  • Phone: 805-794-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC9017
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC9017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: