Provider Demographics
NPI:1578696217
Name:ROGERS, RICHARD RALPH JR (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RALPH
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 1ST ST
Mailing Address - Street 2:STE 242
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4736
Mailing Address - Country:US
Mailing Address - Phone:909-621-9023
Mailing Address - Fax:909-482-2211
Practice Address - Street 1:250 W 1ST ST
Practice Address - Street 2:STE 242
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:909-621-9023
Practice Address - Fax:909-482-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR99573Medicare UPIN