Basic Information
| Provider Information | |||||||||
| NPI: | 1053823518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAIMES PEREZ | ||||||||
| FirstName: | RODOLFO | ||||||||
| MiddleName: | DE JESUS | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3105 WILSON RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933045319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613978775 | ||||||||
| FaxNumber: | 6613978286 | ||||||||
| Practice Location | |||||||||
| Address1: | 3105 WILSON RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933045319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613978775 | ||||||||
| FaxNumber: | 6613978775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2017 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 109207 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 109207 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.