Healthcare Provider Details

I. General information

NPI: 1609474154
Provider Name (Legal Business Name): YANELIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

4880 MARKET ST, VENTURA, CA
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-364-8521
  • Fax:
Mailing address:
  • Phone: 805-364-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: