Healthcare Provider Details

I. General information

NPI: 1639375777
Provider Name (Legal Business Name): YVONNE GABRIELLA RODRIGUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/17/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

IV. Provider business mailing address

2001 E 4TH ST STE 200
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax:
Mailing address:
  • Phone: 562-708-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: