Individual
DIANA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1615 E 17TH ST # 100, SANTA ANA, CA 92705-8529
(714) 955-4042
Mailing address
1615 E 17TH ST # 100, SANTA ANA, CA 92705-8529
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3110116305
MEDI-CAL
CA
Enumeration date
10/16/2013
Last updated
10/16/2013
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