Provider Demographics
NPI:1780944884
Name:RODRIGUEZ, JOSE R
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:RODRIGUEZ
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:PO BOX 435208
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92143-5208
Mailing Address - Country:US
Mailing Address - Phone:619-546-1762
Mailing Address - Fax:
Practice Address - Street 1:206 W SAN YSIDRO BLVD
Practice Address - Street 2:#79
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2485
Practice Address - Country:US
Practice Address - Phone:619-546-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management