Healthcare Provider Details

I. General information

NPI: 1720646623
Provider Name (Legal Business Name): JANETTE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 MOUNT LANGLEY ST STE 220
FOUNTAIN VALLEY CA
92708-6912
US

IV. Provider business mailing address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-2620
  • Fax:
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-951-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: