Healthcare Provider Details

I. General information

NPI: 1023407061
Provider Name (Legal Business Name): CAROL RODRIGUEZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL RAJU LPT

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax: 530-822-7108
Mailing address:
  • Phone: 530-822-7200
  • Fax: 530-822-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number36262
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number95397198
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95397198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: