Healthcare Provider Details

I. General information

NPI: 1174991533
Provider Name (Legal Business Name): BRITANY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 FURUKAWA WAY
SANTA MARIA CA
93458-4929
US

IV. Provider business mailing address

1265 FURUKAWA WAY
SANTA MARIA CA
93458-4929
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax: 805-614-0179
Mailing address:
  • Phone: 805-614-4940
  • Fax: 805-614-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number41145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: