Active NPI
Jorge Rodriguez, O.T.C./C.S.T.
- Surgical Technologist
- San Diego, CA
National Provider Identifier
1992989131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 050842
- Practice address
- 12264 El Camino Real
Suite 101
San Diego, CA 92130-3060 - Phone
- (858) 847-0800
- Fax
- (858) 724-0450
- NPI assigned
- Dec 24, 2007
- 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 |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 050842 | CA | Primary |
Addresses
Primary practice location
12264 El Camino Real
Suite 101
San Diego, CA 92130-3060
Mailing address
12264 El Camino Real
Suite 101
San Diego, CA 92130-3060
Phone (858) 847-0800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050842 | Other | CA | OTC CERTIFICATION |
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 |
|---|---|---|---|
| 050842 | CA | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198454400000",
"number": "1992989131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12264 EL CAMINO REAL",
"address_2": "SUITE 101",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921303060",
"telephone_number": "858-847-0800",
"fax_number": "858-724-0450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12264 EL CAMINO REAL",
"address_2": "SUITE 101",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921303060",
"telephone_number": "858-847-0800",
"fax_number": "858-724-0450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JORGE",
"name_prefix": "Mr.",
"credential": "O.T.C./C.S.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-24",
"last_updated": "2007-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "CA",
"license": "050842",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTC CERTIFICATION",
"identifier": "050842",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.