Healthcare Provider Details

I. General information

NPI: 1992931448
Provider Name (Legal Business Name): HORACIO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD
PASADENA CA
91107-3464
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-1613
  • Fax:
Mailing address:
  • Phone: 626-564-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: