Healthcare Provider Details

I. General information

NPI: 1245193259
Provider Name (Legal Business Name): JOSE JESUS RODRIGUEZ PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 EDENVIEW DR
SAN JOSE CA
95111-4031
US

IV. Provider business mailing address

4587 APTOS AVE
SAN JOSE CA
95111-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-0616
  • Fax:
Mailing address:
  • Phone: 408-509-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210156252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: