Healthcare Provider Details

I. General information

NPI: 1326502923
Provider Name (Legal Business Name): MRS. DAISY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAISY GRACIANO

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 03/06/2025
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 AUBURN BLVD
SACREMENTO CA
95841
US

IV. Provider business mailing address

7824 ROCKHURST WAY
SACRAMENTO CA
95828
US

V. Phone/Fax

Practice location:
  • Phone: 916-771-8255
  • Fax:
Mailing address:
  • Phone: 916-738-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: