Healthcare Provider Details

I. General information

NPI: 1477123677
Provider Name (Legal Business Name): DR. VANESSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 WALL ST UNIT 707
LA JOLLA CA
92038-7030
US

IV. Provider business mailing address

1140 WALL ST UNIT 707
LA JOLLA CA
92038-7030
US

V. Phone/Fax

Practice location:
  • Phone: 858-224-2190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSB94025895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: