Healthcare Provider Details

I. General information

NPI: 1083277958
Provider Name (Legal Business Name): SYLVIA ISABEL RODRIGUEZ SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 RIVER CREST DR STE N
RIVERSIDE CA
92507-0758
US

IV. Provider business mailing address

771 ALISON WAY
SAN JACINTO CA
92583-4882
US

V. Phone/Fax

Practice location:
  • Phone: 951-653-7561
  • Fax:
Mailing address:
  • Phone: 951-345-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7051
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: