Active NPI
Johnny Duarte Rodriguez
- Peer Specialist
- Indio, CA
National Provider Identifier
1558061366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-ELXSHU
- Practice address
- 44199 Monroe St Ste B
Indio, CA 92201-3094 - Phone
- (760) 863-7067
- NPI assigned
- Mar 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | MPSS-ELXSHU | CA | |
| Peer Specialist | 175T00000X | |||
| Peer Specialist | 175T00000X | MPSS-ELXSHU | CA | Primary |
Addresses
Primary practice location
44199 Monroe St Ste B
Indio, CA 92201-3094
Mailing address
44199 Monroe St Ste B
Indio, CA 92201-3094
Phone (760) 863-7067
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 |
|---|---|---|---|
| MPSS-ELXSHU | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703635200000",
"number": "1558061366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44199 MONROE ST STE B",
"city": "INDIO",
"state": "CA",
"postal_code": "922013094",
"telephone_number": "760-863-7067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44199 MONROE ST STE B",
"city": "INDIO",
"state": "CA",
"postal_code": "922013094",
"telephone_number": "760-863-7067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JOHNNY",
"middle_name": "DUARTE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-09",
"last_updated": "2023-12-27",
"certification_date": "2023-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": "MPSS-ELXSHU",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-ELXSHU",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.