Healthcare Provider Details

I. General information

NPI: 1598674558
Provider Name (Legal Business Name): CHRISTIAN ANTHONIO RODRIGUEZ SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 RICHARDS DR
SHAWNEE KS
66216-1724
US

IV. Provider business mailing address

87 MONTEREY LN
OLATHE KS
66061-3042
US

V. Phone/Fax

Practice location:
  • Phone: 913-248-1943
  • Fax: 913-766-1668
Mailing address:
  • Phone: 316-283-6743
  • Fax: 316-283-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number02073
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: