Healthcare Provider Details

I. General information

NPI: 1700648086
Provider Name (Legal Business Name): MISS PRISCILLA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE STE 116
FRESNO CA
93705-4206
US

IV. Provider business mailing address

2550 W CLINTON AVE STE 116
FRESNO CA
93705-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax: 559-570-0388
Mailing address:
  • Phone: 599-264-7521
  • Fax: 559-570-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22279
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: