Provider Demographics
NPI:1629652284
Name:RODRIGUEZ, JULIANNE CECILIA (BCBA)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:CECILIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S COAST DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1534
Mailing Address - Country:US
Mailing Address - Phone:657-444-9002
Mailing Address - Fax:
Practice Address - Street 1:901 FARNAM ST APT 302
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-5042
Practice Address - Country:US
Practice Address - Phone:818-974-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
MN1-23-64731103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician