Provider Demographics
NPI:1285022210
Name:WOOLEY, RODNEY JR (MILITARY)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:WOOLEY
Suffix:JR
Gender:M
Credentials:MILITARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 LOFBERG ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11TH MEU CE DET A
Practice Address - Street 2:UNIT 16131 CLB 11
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96427-6131
Practice Address - Country:US
Practice Address - Phone:619-545-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman