Healthcare Provider Details

I. General information

NPI: 1487105359
Provider Name (Legal Business Name): CHRISTINA RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W AVENUE H12
LANCASTER CA
93534-1919
US

IV. Provider business mailing address

614 W AVENUE H12
LANCASTER CA
93534-1919
US

V. Phone/Fax

Practice location:
  • Phone: 323-829-1124
  • Fax:
Mailing address:
  • Phone: 323-829-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141049
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW136253
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: