Individual
JOHNNY DUARTE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
44199 MONROE ST STE B, INDIO, CA 92201-3094
(760) 863-7067
Mailing address
44199 MONROE ST STE B, INDIO, CA 92201-3094
(760) 863-7067
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
MPSS-ELXSHU
CA
175T00000X
Peer Specialist
Primary
MPSS-ELXSHU
CA
175T00000X
Peer Specialist
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Other
Enumeration date
03/09/2023
Last updated
12/27/2023
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