Healthcare Provider Details

I. General information

NPI: 1679136287
Provider Name (Legal Business Name): ANGELICA PATRICIA RODRIGUEZ ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 ROAD 35
MADERA CA
93636-8487
US

IV. Provider business mailing address

2610 W SHAW LN
FRESNO CA
93711-2775
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: