Healthcare Provider Details

I. General information

NPI: 1164714457
Provider Name (Legal Business Name): JASON CHRISTOPHER RODRIGUEZ IDHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 ALASKAN WAY S
SEATTLE WA
98134-1102
US

IV. Provider business mailing address

1519 ALASKAN WAY S
SEATTLE WA
98134-1102
US

V. Phone/Fax

Practice location:
  • Phone: 206-217-6432
  • Fax:
Mailing address:
  • Phone: 206-217-6432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number4341-4744-6009
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: