Provider Demographics
NPI:1649966904
Name:RASCON, RODOLFO JOEL (DC)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:JOEL
Last Name:RASCON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 SHERMAN HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-3946
Mailing Address - Country:US
Mailing Address - Phone:760-529-7513
Mailing Address - Fax:
Practice Address - Street 1:655 N PALM CANYON DR STE 212
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5529
Practice Address - Country:US
Practice Address - Phone:760-819-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician