Provider Demographics
NPI:1841200581
Name:JOE L ROD MD FACC
Entity Type:Organization
Organization Name:JOE L ROD MD FACC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-993-9511
Mailing Address - Street 1:2020 FOREST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129
Mailing Address - Country:US
Mailing Address - Phone:408-993-9511
Mailing Address - Fax:408-993-9559
Practice Address - Street 1:2020 FOREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129
Practice Address - Country:US
Practice Address - Phone:408-993-9511
Practice Address - Fax:408-993-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42366207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A423661Medicare UPIN