Healthcare Provider Details

I. General information

NPI: 1154279529
Provider Name (Legal Business Name): MR. ROBERT MICHAEL RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N KRAEMER BLVD
PLACENTIA CA
92870-3406
US

IV. Provider business mailing address

325 SILVERLAKE DR
PLACENTIA CA
92870-6451
US

V. Phone/Fax

Practice location:
  • Phone: 562-631-3900
  • Fax:
Mailing address:
  • Phone: 562-631-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: