Provider Demographics
NPI:1912514233
Name:RUPPERT, RODNEY II
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:RUPPERT
Suffix:II
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 1:220 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-7917
Mailing Address - Country:US
Mailing Address - Phone:415-609-6264
Mailing Address - Fax:
Practice Address - Street 1:220 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-7917
Practice Address - Country:US
Practice Address - Phone:415-609-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist