Healthcare Provider Details

I. General information

NPI: 1558289645
Provider Name (Legal Business Name): KEILA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 N BLYTHE AVE STE 102
FRESNO CA
93722-6478
US

IV. Provider business mailing address

4914 E KERCKHOFF AVE
FRESNO CA
93727-3771
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberW1346116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: