Provider Demographics
NPI:1750579033
Name:MCCOUBREY, RODNEY WARREN (HHP)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:WARREN
Last Name:MCCOUBREY
Suffix:
Gender:M
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 DEL RIO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2323
Mailing Address - Country:US
Mailing Address - Phone:760-942-6332
Mailing Address - Fax:
Practice Address - Street 1:844 DEL RIO AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2323
Practice Address - Country:US
Practice Address - Phone:760-942-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist