Provider Demographics
NPI:1306592357
Name:RODRIGUEZ, ESTEFANIA JESUS
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:JESUS
Last Name:RODRIGUEZ
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 1:433 W GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3436
Mailing Address - Country:US
Mailing Address - Phone:805-415-5529
Mailing Address - Fax:
Practice Address - Street 1:433 W GUAVA ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3436
Practice Address - Country:US
Practice Address - Phone:805-415-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90731777DMedicaid