Healthcare Provider Details

I. General information

NPI: 1093689945
Provider Name (Legal Business Name): REBECCA NOEMI RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 FRESNO ST
FRESNO CA
93721-1722
US

IV. Provider business mailing address

4330 ASH ST
FIREBAUGH CA
93622-4424
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-3000
  • Fax:
Mailing address:
  • Phone: 559-253-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW140527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: