Healthcare Provider Details

I. General information

NPI: 1083065379
Provider Name (Legal Business Name): RICHARD RODRIGUEZ SLP-CF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 590W
LOS ANGELES CA
90048-6163
US

IV. Provider business mailing address

5133 FAIRBANKS WAY
CULVER CITY CA
90230-4904
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1220
  • Fax: 310-423-1230
Mailing address:
  • Phone: 310-916-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3392
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: