Provider Demographics
NPI:1245059583
Name:RODRIGUEZ VAZQUEZ, JESUS DANIEL
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:DANIEL
Last Name:RODRIGUEZ VAZQUEZ
Suffix:
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 1:1670 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-4135
Mailing Address - Country:US
Mailing Address - Phone:916-640-5930
Mailing Address - Fax:
Practice Address - Street 1:1679 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4151
Practice Address - Country:US
Practice Address - Phone:707-803-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst