Provider Demographics
NPI:1396592713
Name:RODRIGUEZ BELLO, ERNEST (RADT # R1583851024)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:RODRIGUEZ BELLO
Suffix:
Gender:M
Credentials:RADT # R1583851024
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 MAGNOLIA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3449
Mailing Address - Country:US
Mailing Address - Phone:951-934-8183
Mailing Address - Fax:
Practice Address - Street 1:7344 MAGNOLIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3819
Practice Address - Country:US
Practice Address - Phone:805-622-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171400000X, 171M00000X
CAR1583851024101YA0400X
CAMPSS-FXZUKN175T00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist