Individual
JESUS PRIMITIVO RENDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5620 S REGAL ST STE 11, SPOKANE, WA 99223-7957
(509) 444-8200
Mailing address
611 N IRON BRIDGE WAY, SPOKANE, WA 99202-4932
(509) 444-8888
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60932463
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OA60965163
STATE LICENSE
WA
01
—
PA60932463
STATE LICENSE
WA
Enumeration date
09/07/2017
Last updated
04/20/2023
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