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General NPI Number Information
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NPI Number | 1649094509
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Entity Type | Individual
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Provider Name | RAMON BARAJAS JR. RODRIGUEZ PTA
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Gender | Male
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 442 E HAMPTON ST
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City | STOCKTON
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State | CA
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Zip | 95204-5519
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Country | US
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Telephone | 209-466-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 TOM LN
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City | STOCKTON
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State | CA
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Zip | 95206-6140
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Country | US
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Telephone | 209-585-5267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53656
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License Number State | CA
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