Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033302468 |
---|---|
Provider Name | Gloria R Rodriguez |
First Address | Los Angeles, CA 90063-2117 |
Second Address | Los Angeles, CA 90063-2117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 24/06/2021 |