Provider Demographics
NPI:1083065379
Name:RODRIGUEZ, RICHARD (SLP-CF)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 FAIRBANKS WAY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4904
Mailing Address - Country:US
Mailing Address - Phone:310-916-6767
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 590W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6163
Practice Address - Country:US
Practice Address - Phone:310-423-1220
Practice Address - Fax:310-423-1230
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10671235Z00000X
33922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant