Healthcare Provider Details

I. General information

NPI: 1083083125
Provider Name (Legal Business Name): LESLY RODRIGUEZ M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE
WESTMINSTER CA
92683-2900
US

IV. Provider business mailing address

13950 MILTON AVE STE 306
WESTMINSTER CA
92683-2939
US

V. Phone/Fax

Practice location:
  • Phone: 714-793-1290
  • Fax: 714-793-1267
Mailing address:
  • Phone: 714-793-1290
  • Fax: 714-793-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: