Healthcare Provider Details

I. General information

NPI: 1689077752
Provider Name (Legal Business Name): MIGUEL RODRIGUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BRESLAUER WAY
REDDING CA
96001-4246
US

IV. Provider business mailing address

26137 LA PAZ RD STE 230
MISSION VIEJO CA
92691-5337
US

V. Phone/Fax

Practice location:
  • Phone: 530-229-8269
  • Fax: 530-229-8322
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-951-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: