Healthcare Provider Details

I. General information

NPI: 1508478538
Provider Name (Legal Business Name): RODOLFO INAKI RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 BROADWAY STE 6
CHULA VISTA CA
91911-2770
US

IV. Provider business mailing address

1177 BROADWAY STE 6
CHULA VISTA CA
91911-2770
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 858-264-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: