Individual
JESUS RODRIGUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
Mailing address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33786
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
CA
Enumeration date
05/08/2015
Last updated
05/08/2015
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