Provider Demographics
NPI:1861860843
Name:RODRIGUEZ-CORNELIUS, NAOMI
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:RODRIGUEZ-CORNELIUS
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 1:12423 DAHLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3611
Mailing Address - Country:US
Mailing Address - Phone:626-258-0310
Mailing Address - Fax:626-401-2562
Practice Address - Street 1:845 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2535
Practice Address - Country:US
Practice Address - Phone:626-258-0310
Practice Address - Fax:626-401-2562
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1008301128101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)