Healthcare Provider Details

I. General information

NPI: 1245012962
Provider Name (Legal Business Name): JENEVY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

IV. Provider business mailing address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

V. Phone/Fax

Practice location:
  • Phone: 619-863-5701
  • Fax:
Mailing address:
  • Phone: 619-863-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: