Provider Demographics
NPI:1982021051
Name:RINCON, JOSE JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RINCON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2927
Mailing Address - Country:US
Mailing Address - Phone:510-465-4569
Mailing Address - Fax:
Practice Address - Street 1:425 VERNON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2927
Practice Address - Country:US
Practice Address - Phone:510-465-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
942171008OtherDRUG AND ALCOHOL