Healthcare Provider Details

I. General information

NPI: 1558826578
Provider Name (Legal Business Name): NANCY RAQUEL RODRIGUEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 731
SOUTH GATE CA
90280-0731
US

IV. Provider business mailing address

PO BOX 731
SOUTH GATE CA
90280-0731
US

V. Phone/Fax

Practice location:
  • Phone: 323-364-4070
  • Fax:
Mailing address:
  • Phone: 323-364-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT162433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: