Provider Demographics
NPI:1770158552
Name:RODRIGUEZ TORRES, MITZI JOSSELINE
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:JOSSELINE
Last Name:RODRIGUEZ TORRES
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 1:2728 W YALE AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4854
Mailing Address - Country:US
Mailing Address - Phone:714-451-5000
Mailing Address - Fax:
Practice Address - Street 1:2130 E 4TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3842
Practice Address - Country:US
Practice Address - Phone:714-356-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health