Healthcare Provider Details

I. General information

NPI: 1760902597
Provider Name (Legal Business Name): ARTEMIO RODRIGUEZ ENRIQUEZ ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD STE 230
PASADENA CA
91107-1449
US

IV. Provider business mailing address

12747 MERCER ST APT A5
PACOIMA CA
91331-1301
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 818-720-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61718
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: