Individual ProviderIvette G RodriguezBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324(760) 550-3836PECOS EnrollmentBased on the most recent information from CMS, provider Ivette G Rodriguez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1104513613Provider TypeIndividualFull NameRodriguez, Ivette GGenderFemaleSole ProprietorNoEnumeration Date4/24/2023Last Updated4/25/2023Contact InformationPractice LocationPractice Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324Phone(760) 550-3836FaxUnlisted FaxMailing LocationMailing Address9620 Chesapeake Dr Ste 105, San Diego, CA 92123-1324PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer