Healthcare Provider Details

I. General information

NPI: 1063587376
Provider Name (Legal Business Name): JEANNINE MARIE RODEMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SOQUEL AVE STE 100
SANTA CRUZ CA
95062-2097
US

IV. Provider business mailing address

9000 SOQUEL AVE STE 100
SANTA CRUZ CA
95062-2097
US

V. Phone/Fax

Practice location:
  • Phone: 831-708-1400
  • Fax: 831-708-1390
Mailing address:
  • Phone: 831-708-1400
  • Fax: 831-708-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG81126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: