Provider Demographics
NPI:1437881489
Name:RODRIGUEZ, CANDICE DANIELLA CATALEN
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:DANIELLA CATALEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S NEWHOPE ST APT 21
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2186
Mailing Address - Country:US
Mailing Address - Phone:714-300-3143
Mailing Address - Fax:
Practice Address - Street 1:1650 E OLD BADILLO ST # B3
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3163
Practice Address - Country:US
Practice Address - Phone:626-251-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW903541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical