Healthcare Provider Details

I. General information

NPI: 1508789967
Provider Name (Legal Business Name): HEKANNE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

350 W BROOKSIDE AVE
CHERRY VALLEY CA
92223-4073
US

IV. Provider business mailing address

29536 CLEAR VIEW LN
HIGHLAND CA
92346-7707
US

V. Phone/Fax

Practice location:
  • Phone: 909-557-4650
  • Fax:
Mailing address:
  • Phone: 909-557-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: