Healthcare Provider Details

I. General information

NPI: 1184580235
Provider Name (Legal Business Name): ELIJAH RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 300
TEMECULA CA
92591-4678
US

IV. Provider business mailing address

360 LORI ANN ST
SAN JACINTO CA
92582-3155
US

V. Phone/Fax

Practice location:
  • Phone: 951-466-3196
  • Fax:
Mailing address:
  • Phone: 951-590-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: