Healthcare Provider Details

I. General information

NPI: 1497962476
Provider Name (Legal Business Name): FIDEL HIGINIO RODRIGUEZ MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 ELDRIDGE AVE
SYLMAR CA
91342-6506
US

IV. Provider business mailing address

10155 COLIMA RD
WHITTIER CA
90603-2042
US

V. Phone/Fax

Practice location:
  • Phone: 818-686-3000
  • Fax: 818-686-6300
Mailing address:
  • Phone: 562-692-0383
  • Fax: 562-692-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF-60253
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: