Healthcare Provider Details

I. General information

NPI: 1770410904
Provider Name (Legal Business Name): RUBY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W LOMITA AVE
GLENDALE CA
91204-1512
US

IV. Provider business mailing address

613 N GOWER ST
LOS ANGELES CA
90004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-0450
  • Fax:
Mailing address:
  • Phone: 323-896-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: