Healthcare Provider Details

I. General information

NPI: 1114764347
Provider Name (Legal Business Name): ASHLEY MELISSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 CALIFORNIA AVE
SOUTH GATE CA
90280-3013
US

IV. Provider business mailing address

5901 GREEN VALLEY CIR STE 405
CULVER CITY CA
90230-6971
US

V. Phone/Fax

Practice location:
  • Phone: 323-487-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: