Healthcare Provider Details

I. General information

NPI: 1720099427
Provider Name (Legal Business Name): JERRY RHODES AINSWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

PO BOX HH BUSINESS DEVELOPMENT & CONTRACTING
MONTEREY CA
93942
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax: 831-625-4948
Mailing address:
  • Phone: 831-622-2716
  • Fax: 831-625-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA81400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: