Healthcare Provider Details

I. General information

NPI: 1306185178
Provider Name (Legal Business Name): JUAN MANUEL RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 N MAIN ST STE 400
SANTA ANA CA
92701-7417
US

IV. Provider business mailing address

300 N RAMPART ST TRLR 59
ORANGE CA
92868-1804
US

V. Phone/Fax

Practice location:
  • Phone: 714-704-5900
  • Fax:
Mailing address:
  • Phone: 714-234-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: