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General NPI Number Information
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NPI Number | 1932195195
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Entity Type | Organization
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Legal Business Name | RODNEY D. HENSON
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 2540 PACIFIC AVE SUITE 2B
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City | STOCKTON
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State | CA
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Zip | 95204-4400
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Country | US
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Telephone | 209-944-9990
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Fax | 209-944-9992
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Provider Business Mailing Address
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Address Line | 2540 PACIFIC AVE SUITE 2B
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City | STOCKTON
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State | CA
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Zip | 95204-4400
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Country | US
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Telephone | 209-944-9990
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Fax | 209-944-9992
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Authorized Official
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Title or Position | OWNER
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Name | MR. RODNEY DOUGLAS HENSON
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Credential | CPO 02313
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Telephone | 209-944-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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