Provider Demographics
NPI:1972092666
Name:RODRIGUEZ, ISRAEL I II
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:I
Last Name:RODRIGUEZ
Suffix:II
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 1:44362 GALLIPOLI PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-9177
Mailing Address - Country:US
Mailing Address - Phone:951-214-5128
Mailing Address - Fax:
Practice Address - Street 1:26900 NEWPORT RD STE 111
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9224
Practice Address - Country:US
Practice Address - Phone:951-309-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2023-06-09
Deactivation Date:2023-05-18
Deactivation Code:
Reactivation Date:2023-06-09
Provider Licenses
StateLicense IDTaxonomies
CAF7553456103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst