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NPI Code Detail

MEDICARE: MS. JULIE ANN RODRIGUEZ

MEDICARE: MS. JULIE ANN RODRIGUEZ
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
1225400000XRehabilitation Practitioner
2106H00000XMarriage & Family TherapistIMF62776CA
3101YM0800XMental Health CounselorIMF62776CA

General Provider Information

NPI Number : 1427187236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE ANN RODRIGUEZ
Provider Business Mailing Address
First Line : 12099 W WASHINGTON BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-5882
Country : US
Telephone Number : 818-809-4188
Fax Number :
Provider Business Practice Location Address
First Line : 15339 SATICOY ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-3345
Country : US
Telephone Number : 818-809-4188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 01/10/2017

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