Healthcare Provider Details

I. General information

NPI: 1538848460
Provider Name (Legal Business Name): KENZIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7934 LEMON HILL AVE
SACRAMENTO CA
95824-3345
US

IV. Provider business mailing address

7786 CHANCERY CT
CITRUS HEIGHTS CA
95610-5904
US

V. Phone/Fax

Practice location:
  • Phone: 916-395-4555
  • Fax:
Mailing address:
  • Phone: 916-296-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA6730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: