Active NPI
Raymond Rudolph Rendon, B.C.O.
- Prosthetics Case Management
- San Jose, CA
National Provider Identifier
1710097613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- Practice address
- 2039 Forest Ave Ste 206
San Jose, CA 95128-4815 - Phone
- (408) 297-4850
- Fax
- (408) 297-0676
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | Primary |
Addresses
Primary practice location
2039 Forest Ave Ste 206
San Jose, CA 95128-4815
Mailing address
2039 Forest Ave Ste 206
San Jose, CA 95128-4815
Phone (408) 297-4850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DXX00008F | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930014419 | CA | DME Supplier - Ocularist | 7618095423 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: San Jose, CA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204675200000",
"number": "1710097613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2039 FOREST AVE STE 206",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284815",
"telephone_number": "408-297-4850",
"fax_number": "408-297-0676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2039 FOREST AVE STE 206",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284815",
"telephone_number": "408-297-4850",
"fax_number": "408-297-0676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENDON",
"first_name": "RAYMOND",
"middle_name": "RUDOLPH",
"name_prefix": "Mr.",
"credential": "B.C.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2008-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DXX00008F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.