Provider Demographics
NPI:1083083125
Name:RODRIGUEZ, LESLY (MSW)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13950 MILTON AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2939
Mailing Address - Country:US
Mailing Address - Phone:714-793-1290
Mailing Address - Fax:714-793-1267
Practice Address - Street 1:13950 MILTON AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2900
Practice Address - Country:US
Practice Address - Phone:714-793-1290
Practice Address - Fax:714-793-1267
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool