Healthcare Provider Details

I. General information

NPI: 1740100817
Provider Name (Legal Business Name): IMAN MICHELLE RODRIGUEZ-VERDEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23300 CINEMA DR STE 210
VALENCIA CA
91355-1776
US

IV. Provider business mailing address

2806 W AVENUE 30
LOS ANGELES CA
90065-1304
US

V. Phone/Fax

Practice location:
  • Phone: 661-287-3939
  • Fax:
Mailing address:
  • Phone: 323-631-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: