Active NPI
Jennie Rodriguez
- Specialist
- Stockton, CA
National Provider Identifier
1467270264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- LIC-116144
- Practice address
- 37 W Yokuts Ave Ste B
Stockton, CA 95207-5727 - Phone
- (209) 403-4216
- NPI assigned
- Sep 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | LIC-116144 | CA | Primary |
Addresses
Primary practice location
37 W Yokuts Ave Ste B
Stockton, CA 95207-5727
Mailing address
436 Cowell Ave
Manteca, CA 95336-5908
Phone (209) 403-4216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LIC-116144 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727654400000",
"number": "1467270264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 COWELL AVE",
"city": "MANTECA",
"state": "CA",
"postal_code": "953365908",
"telephone_number": "209-403-4216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 W YOKUTS AVE STE B",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952075727",
"telephone_number": "209-403-4216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JENNIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-30",
"last_updated": "2024-09-30",
"certification_date": "2024-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "LIC-116144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.