Healthcare Provider Details

I. General information

NPI: 1326766908
Provider Name (Legal Business Name): CURTIS LEE RHODES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 E COVINA BLVD
COVINA CA
91724-1523
US

IV. Provider business mailing address

11852 MOUNT VERNON AVE APT T543
GRAND TERRACE CA
92313-8207
US

V. Phone/Fax

Practice location:
  • Phone: 626-966-1632
  • Fax:
Mailing address:
  • Phone: 909-754-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number673838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: