Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2000007810 | CA |
NPI | 1730726894 |
---|---|
Provider Name | Jamie Rodgers |
First Address | San Juan Capistrano, CA 92675-1635 |
Second Address | San Juan Capistrano, CA 92675-1635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2019 |
Last Update Date | 06/12/2019 |