Provider Demographics
NPI:1538597059
Name:RODRIGUEZ, DAISY ELIZABETH
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:ELIZABETH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 1ST ST APT 37
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3141
Mailing Address - Country:US
Mailing Address - Phone:323-829-4996
Mailing Address - Fax:
Practice Address - Street 1:1221 E DYER RD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5635
Practice Address - Country:US
Practice Address - Phone:714-334-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health