Provider Demographics
NPI:1235620766
Name:RODRIGUEZ, JARROD K (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3927
Mailing Address - Country:US
Mailing Address - Phone:559-303-4655
Mailing Address - Fax:
Practice Address - Street 1:1212 HANNA AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2313
Practice Address - Country:US
Practice Address - Phone:559-992-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily