Provider Demographics
NPI:1174116792
Name:RODRIGUEZ, CHRISTELLE DOREESE (RAC)
Entity type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:DOREESE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S ARROYO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3973
Mailing Address - Country:US
Mailing Address - Phone:626-403-2794
Mailing Address - Fax:
Practice Address - Street 1:1020 S ARROYO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3973
Practice Address - Country:US
Practice Address - Phone:626-403-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
CA13970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist