Healthcare Provider Details

I. General information

NPI: 1396150355
Provider Name (Legal Business Name): VALERIE BANDA-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 LIME ST BLDG 2
RIVERSIDE CA
92501-2971
US

IV. Provider business mailing address

3600 LIME ST BLDG 2
RIVERSIDE CA
92501-2971
US

V. Phone/Fax

Practice location:
  • Phone: 951-880-7048
  • Fax:
Mailing address:
  • Phone: 951-880-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW68489
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW88886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: