Healthcare Provider Details

I. General information

NPI: 1225427495
Provider Name (Legal Business Name): MARIA GABRIELA RODRIGUEZ BUSTAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD
PASADENA CA
91107-3406
US

IV. Provider business mailing address

5335 HESS RD
PHELAN CA
92371-8909
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5230
  • Fax:
Mailing address:
  • Phone: 626-485-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: