Provider Demographics
NPI:1710960877
Name:RODICK, JAMES DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:RODICK
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:13193 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7200
Mailing Address - Country:US
Mailing Address - Phone:909-902-9111
Mailing Address - Fax:909-902-9199
Practice Address - Street 1:954 W FOOTHILL BLVD
Practice Address - Street 2:FOOTHILLS PSYCHOLOGICAL SERVICES SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3782
Practice Address - Country:US
Practice Address - Phone:909-946-4222
Practice Address - Fax:909-946-8243
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY9588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R26473Medicare UPIN
CA00PL95881Medicare ID - Type Unspecified