Provider Demographics
NPI:1699806521
Name:RHOADES, MIKE (PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:RHOADES
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N L ST APT 137
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3354
Mailing Address - Country:US
Mailing Address - Phone:800-688-6550
Mailing Address - Fax:
Practice Address - Street 1:240 E HIGHWAY 246 STE 300
Practice Address - Street 2:
Practice Address - City:BUELLTON
Practice Address - State:CA
Practice Address - Zip Code:93427-9648
Practice Address - Country:US
Practice Address - Phone:800-688-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health