Provider Demographics
NPI:1619482304
Name:RODRIGUEZ ORELLANA, REINA ESMERALDA
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:ESMERALDA
Last Name:RODRIGUEZ ORELLANA
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 1:16500 VENTURA BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2013
Mailing Address - Country:US
Mailing Address - Phone:818-616-5022
Mailing Address - Fax:818-664-4082
Practice Address - Street 1:20235 SHERMAN WAY APT 108
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3236
Practice Address - Country:US
Practice Address - Phone:818-723-5335
Practice Address - Fax:818-723-5335
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty