Provider Demographics
NPI:1972365955
Name:RODRIGUEZ, JOSHUA ALEXANDER
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALEXANDER
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 1:7051 DEL NORTE DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1407
Mailing Address - Country:US
Mailing Address - Phone:805-891-8264
Mailing Address - Fax:
Practice Address - Street 1:7051 DEL NORTE DR
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1407
Practice Address - Country:US
Practice Address - Phone:805-694-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-HVTDIN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist