Provider Demographics
NPI:1639957657
Name:RODRIGUEZ, BELISA CRISTINA
Entity Type:Individual
Prefix:
First Name:BELISA
Middle Name:CRISTINA
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 1:13652 COPE CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9648
Mailing Address - Country:US
Mailing Address - Phone:951-421-4097
Mailing Address - Fax:
Practice Address - Street 1:2761 SATURN ST STE J
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6707
Practice Address - Country:US
Practice Address - Phone:562-889-4256
Practice Address - Fax:888-891-6599
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23-302252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician