Healthcare Provider Details

I. General information

NPI: 1932851573
Provider Name (Legal Business Name): KANYA ANNETTE RODRIGUEZ MHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANYA ANNETTE ZEPEDA ARREDONDO

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 KEARNY VILLA RD STE 300
SAN DIEGO CA
92123-1142
US

IV. Provider business mailing address

5473 KEARNY VILLA RD STE 300
SAN DIEGO CA
92123-1142
US

V. Phone/Fax

Practice location:
  • Phone: 619-379-6934
  • Fax:
Mailing address:
  • Phone: 858-298-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26526
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: