Healthcare Provider Details

I. General information

NPI: 1568158558
Provider Name (Legal Business Name): CHELSEA CAMILLE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21535 HAWTHORNE BLVD STE 102
TORRANCE CA
90503-6626
US

IV. Provider business mailing address

5850 GRANITE PKWY STE 600
PLANO TX
75024-6753
US

V. Phone/Fax

Practice location:
  • Phone: 310-817-2177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: