Provider Demographics
NPI:1942860853
Name:A J ROGERS, MD, INC
Entity Type:Organization
Organization Name:A J ROGERS, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:A J
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-370-4400
Mailing Address - Street 1:32158 CAMINO CAPISTRANO STE A267
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3720
Mailing Address - Country:US
Mailing Address - Phone:909-370-4400
Mailing Address - Fax:909-370-4405
Practice Address - Street 1:1550 E WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4624
Practice Address - Country:US
Practice Address - Phone:909-370-4400
Practice Address - Fax:909-370-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5656453OtherDELAWARE FILE NO.