Provider Demographics
NPI:1760004204
Name:RODRIGUEZ, LORENZO A
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:A
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 1:114 S BRAWLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2103
Mailing Address - Country:US
Mailing Address - Phone:559-443-2166
Mailing Address - Fax:
Practice Address - Street 1:7171 W RIALTO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93723-9407
Practice Address - Country:US
Practice Address - Phone:559-307-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness