Provider Demographics
NPI:1437144540
Name:JAN LOUISE RODRIGUEZ
Entity Type:Organization
Organization Name:JAN LOUISE RODRIGUEZ
Other - Org Name:QUALITY DME SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-825-5213
Mailing Address - Street 1:12210 MICHIGAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5484
Mailing Address - Country:US
Mailing Address - Phone:909-825-5213
Mailing Address - Fax:909-825-2843
Practice Address - Street 1:12210 MICHIGAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5484
Practice Address - Country:US
Practice Address - Phone:909-825-5213
Practice Address - Fax:909-825-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02924FMedicaid
CADME02924FOtherMEDICAL PROVIDER #
CA1285600001Medicare NSC