Provider Demographics
NPI:1073760989
Name:BLEDSOE, RODNEY MARCEL
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:MARCEL
Last Name:BLEDSOE
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 1:1200 AGUAJITO RD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4887
Mailing Address - Country:US
Mailing Address - Phone:831-647-7652
Mailing Address - Fax:831-647-7940
Practice Address - Street 1:1200 AGUAJITO RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4887
Practice Address - Country:US
Practice Address - Phone:831-647-7652
Practice Address - Fax:831-647-7940
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator