Provider Demographics
NPI:1134439318
Name:RODRIGUEZ, FELIPE (CAADE)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CAADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-2554
Mailing Address - Country:US
Mailing Address - Phone:323-221-1746
Mailing Address - Fax:323-221-5176
Practice Address - Street 1:4099 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-2554
Practice Address - Country:US
Practice Address - Phone:323-221-1746
Practice Address - Fax:323-221-5176
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190007KN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)