MEDICARE: JOSE RINCON JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	20972	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	942171008	OTHER		DRUG AND ALCOHOL

General Provider Information

NPI Number	:	1982021051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE RINCON JR.

Provider Business Mailing Address
First Line	:	425 VERNON ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-2927
Country	:	US
Telephone Number	:	510-465-4569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 FAIRMONT DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94578-1088
Country	:	US
Telephone Number	:	510-582-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	05/16/2025

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