Healthcare Provider Details

I. General information

NPI: 1780827220
Provider Name (Legal Business Name): RUDOLPH SANCHEZ COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

IV. Provider business mailing address

942 S ATLANTIC BLVD
LOS ANGELES CA
90022-4004
US

V. Phone/Fax

Practice location:
  • Phone: 818-345-2345
  • Fax:
Mailing address:
  • Phone: 323-263-9700
  • Fax: 323-263-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: