Provider Demographics
NPI:1366781197
Name:RODRIGUEZ, JESSE ROBERT
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:ROBERT
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48-5194 HONOKAA WAIPIO RD
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-7200
Mailing Address - Country:US
Mailing Address - Phone:808-238-5887
Mailing Address - Fax:
Practice Address - Street 1:1100 ALAKEA ST FL 9
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2833
Practice Address - Country:US
Practice Address - Phone:808-523-5990
Practice Address - Fax:808-523-1997
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor