Provider Demographics
NPI:1972789626
Name:RODRIGUEZ, ISIDRO JR
Entity Type:Individual
Prefix:
First Name:ISIDRO
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 RONAN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2529
Mailing Address - Country:US
Mailing Address - Phone:562-896-7543
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-532-6030
Practice Address - Fax:310-532-8441
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner