Provider Demographics
NPI:1891939419
Name:RODOLFO DE LOS SANTOS ONGJOCO, JR., MD, PA
Entity Type:Organization
Organization Name:RODOLFO DE LOS SANTOS ONGJOCO, JR., MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:S
Authorized Official - Last Name:ONGJOCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MC
Authorized Official - Phone:910-246-0567
Mailing Address - Street 1:180 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7020
Mailing Address - Country:US
Mailing Address - Phone:910-246-0567
Mailing Address - Fax:
Practice Address - Street 1:180 PERRY DR
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7020
Practice Address - Country:US
Practice Address - Phone:910-246-0567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95001702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty