Provider Demographics
NPI:1720408685
Name:RODGERS, JOSHUA (CNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 HILLSIDE AVE
Mailing Address - Street 2:APT 114
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2360
Mailing Address - Country:US
Mailing Address - Phone:323-399-8801
Mailing Address - Fax:
Practice Address - Street 1:7245 HILLSIDE AVE
Practice Address - Street 2:APT 114
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2360
Practice Address - Country:US
Practice Address - Phone:323-399-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892204372600000X, 3747P1801X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide