Provider Demographics
NPI:1063129211
Name:RODRIGUEZ, GIOVANNY JOSE
Entity type:Individual
Prefix:
First Name:GIOVANNY
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13666 SCHAYLEEN CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-1707
Mailing Address - Country:US
Mailing Address - Phone:951-483-3049
Mailing Address - Fax:
Practice Address - Street 1:13666 SCHAYLEEN CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-1707
Practice Address - Country:US
Practice Address - Phone:951-483-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician