Healthcare Provider Details

I. General information

NPI: 1467775593
Provider Name (Legal Business Name): JULIAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 N BUSH ST
SANTA ANA CA
92706-2816
US

IV. Provider business mailing address

13924 TAFT ST APT 2
GARDEN GROVE CA
92843-3388
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-4860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: