Healthcare Provider Details

I. General information

NPI: 1083347462
Provider Name (Legal Business Name): MRS. LAURA MARIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 MORENA BLVD
SAN DIEGO CA
92110-3889
US

IV. Provider business mailing address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

V. Phone/Fax

Practice location:
  • Phone: 161-945-5274
  • Fax:
Mailing address:
  • Phone: 619-398-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: