Individual
JASON L RODDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
25815 BARTON RD STE 101, LOMA LINDA, CA 92354-3894
(909) 796-0224
(909) 796-0225
Mailing address
25815 BARTON RD, STE 101, LOMA LINDA, CA 92354-3894
(909) 796-0224
(909) 796-0225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA18638
CA
363AS0400X
Surgical Physician Assistant
Primary
PA18638
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AR447Z
INDIVIDUAL PTAN
—
Enumeration date
11/01/2006
Last updated
12/09/2020
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