Provider Demographics
NPI:1831981349
Name:RODRIGUEZ, LYNN ROSE (EDD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ROSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 VALENCIA ST APT 324
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2094
Mailing Address - Country:US
Mailing Address - Phone:310-259-8864
Mailing Address - Fax:
Practice Address - Street 1:201 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4637
Practice Address - Country:US
Practice Address - Phone:310-725-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool