1083253371 NPI number — JESUS RODRIGUEZ

Table of content: JESUS RODRIGUEZ (NPI 1083253371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083253371 NPI number — JESUS RODRIGUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
JESUS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083253371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E. AIRPORT DR. SUITE 150 SAN BENARDINO, CA 92408
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BENARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-206-1009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E AIRPORT DR STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-3429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-206-1009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com