Healthcare Provider Details

I. General information

NPI: 1255235487
Provider Name (Legal Business Name): IZABELLA JILLIAN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N CALAVERAS ST
FRESNO CA
93701-1805
US

IV. Provider business mailing address

324 N CALAVERAS ST
FRESNO CA
93701-1805
US

V. Phone/Fax

Practice location:
  • Phone: 559-540-0164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number27004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: