Healthcare Provider Details

I. General information

NPI: 1932770450
Provider Name (Legal Business Name): CELINA PEARL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 02/03/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 DEW POINT WAY
FONTANA CA
92336-1865
US

IV. Provider business mailing address

10261 TRADEMARK ST STE C
RANCHO CUCAMONGA CA
91730-5805
US

V. Phone/Fax

Practice location:
  • Phone: 909-317-8499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: