Healthcare Provider Details

I. General information

NPI: 1871257634
Provider Name (Legal Business Name): DAISY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

1507 W 56TH ST
LOS ANGELES CA
90062-2817
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6380
  • Fax:
Mailing address:
  • Phone: 323-423-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberD6415028
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: