Basic Information
| Provider Information | |||||||||
| NPI: | 1366613945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | LIZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1816 S FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132642039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 S ATLANTIC BLVD | ||||||||
| Address2: | 207 | ||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238871917 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2008 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.