Healthcare Provider Details

I. General information

NPI: 1811727274
Provider Name (Legal Business Name): JENNIFER RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 JADESTONE LN
CORONA CA
92882-3873
US

IV. Provider business mailing address

1581 JADESTONE LN
CORONA CA
92882-3873
US

V. Phone/Fax

Practice location:
  • Phone: 714-943-2516
  • Fax:
Mailing address:
  • Phone: 714-943-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133876
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: