Basic Information
| Provider Information | |||||||||
| NPI: | 1124757968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4420 STILLWELL AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900321236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232531547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1245 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267959127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 15730-RADT | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.