Healthcare Provider Details

I. General information

NPI: 1366388415
Provider Name (Legal Business Name): EDWARD RODEZNO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 ARGONNE AVE
LONG BEACH CA
90815-2527
US

IV. Provider business mailing address

1515 HUGHES WAY
LONG BEACH CA
90810-1865
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-8000
  • Fax:
Mailing address:
  • Phone: 562-997-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: