Healthcare Provider Details

I. General information

NPI: 1568600583
Provider Name (Legal Business Name): VICTOR ROSARIO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N LOCUST ST
VISALIA CA
93291-4946
US

IV. Provider business mailing address

220 N LOCUST ST
VISALIA CA
93291-4946
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1385
  • Fax: 559-636-2105
Mailing address:
  • Phone: 559-627-1385
  • Fax: 559-636-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE1435996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: