Provider Demographics
NPI:1760021943
Name:RODRIGUEZ, VIRIDIANA
Entity Type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
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 1:1777 N BELLFLOWER BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4020
Mailing Address - Country:US
Mailing Address - Phone:714-600-9762
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4020
Practice Address - Country:US
Practice Address - Phone:714-900-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical