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NPI Code Detail

MEDICARE: MR. GABRIEL R RODRIGUEZ JR. M.S., BCBA

MEDICARE: MR. GABRIEL R RODRIGUEZ JR. M.S., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-17-28481CA

General Provider Information

NPI Number : 1316453566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GABRIEL R RODRIGUEZ JR. M.S., BCBA
Provider Business Mailing Address
First Line : 4221 WILSHIRE BLVD STE 300A
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-3537
Country : US
Telephone Number : 888-428-3223
Fax Number : 323-866-1881
Provider Business Practice Location Address
First Line : 6370 MAGNOLIA AVE STE 340
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-2404
Country : US
Telephone Number : 888-428-3223
Fax Number : 323-866-1881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2017
Last Update Date : 04/20/2021

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