Provider Demographics
NPI:1902377237
Name:RODRIGUEZ, JESUS BAUTISTA (LMT)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:BAUTISTA
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S 38TH AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3980
Mailing Address - Country:US
Mailing Address - Phone:509-388-5566
Mailing Address - Fax:
Practice Address - Street 1:3910 SUMMITVIEW AVE STE 210
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2780
Practice Address - Country:US
Practice Address - Phone:509-966-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60736453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist