Healthcare Provider Details

I. General information

NPI: 1427832534
Provider Name (Legal Business Name): JULISSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULISSA CHAVEZ

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 6TH ST
WASCO CA
93280-1948
US

IV. Provider business mailing address

820 6TH ST
WASCO CA
93280-1948
US

V. Phone/Fax

Practice location:
  • Phone: 661-772-5269
  • Fax:
Mailing address:
  • Phone: 661-758-4029
  • Fax: 661-758-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: