Provider Demographics
NPI:1184963670
Name:RHODES, ROBERTA JEAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:RHODES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:SUITE 2-701
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:619-543-6560
Mailing Address - Fax:619-543-6992
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:SUITE 2-701
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-543-6560
Practice Address - Fax:619-543-6992
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256205363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA256205OtherCALIFORNIA RN LICENSE NUMBER