Provider Demographics
NPI:1316814619
Name:RODRIGUEZ, ELSA (RBT)
Entity type:Individual
Prefix:MS
First Name:ELSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 IRVINE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3399
Mailing Address - Country:US
Mailing Address - Phone:657-333-6085
Mailing Address - Fax:714-242-1646
Practice Address - Street 1:18002 IRVINE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3399
Practice Address - Country:US
Practice Address - Phone:657-333-6085
Practice Address - Fax:714-242-1646
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-23-296365106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician