Provider Demographics
NPI:1679316657
Name:RODRIGUEZ, XIMENA BETZABEL
Entity type:Individual
Prefix:
First Name:XIMENA
Middle Name:BETZABEL
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 1:1380 N CITRUS AVE TRLR F8
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1744
Mailing Address - Country:US
Mailing Address - Phone:626-438-3464
Mailing Address - Fax:
Practice Address - Street 1:1900 W GARVEY AVE S STE 168
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2653
Practice Address - Country:US
Practice Address - Phone:626-778-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician