Healthcare Provider Details

I. General information

NPI: 1194640953
Provider Name (Legal Business Name): ANGELIQUE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12062 VALLEY VIEW ST STE 220
GARDEN GROVE CA
92845-1739
US

IV. Provider business mailing address

2406 E 109TH ST # 2
LOS ANGELES CA
90059-1410
US

V. Phone/Fax

Practice location:
  • Phone: 562-356-8600
  • Fax:
Mailing address:
  • Phone: 424-200-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: