Healthcare Provider Details

I. General information

NPI: 1417293150
Provider Name (Legal Business Name): JODECI RINCON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SHAW AVE STE 103
CLOVIS CA
93612-3985
US

IV. Provider business mailing address

2590 S EZIE AVE
FRESNO CA
93727-6581
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: