Healthcare Provider Details

I. General information

NPI: 1184871113
Provider Name (Legal Business Name): JESSICA RODRIGUEZ OHANESIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA M RODRIGUEZ MS, PA-C

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE.
CLOVIS CA
93611-0000
US

IV. Provider business mailing address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4027
  • Fax:
Mailing address:
  • Phone: 559-324-4027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19876
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: