Healthcare Provider Details

I. General information

NPI: 1023932142
Provider Name (Legal Business Name): ALEXIE LEANNE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

566 S BRAND BLVD
SAN FERNANDO CA
91340-4002
US

IV. Provider business mailing address

13141 MILLRACE ST
SUN VALLEY CA
91352-3716
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-0223
  • Fax: 818-593-4205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: