Basic Information
| Provider Information | |||||||||
| NPI: | 1710960877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODICK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13193 CENTRAL AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917107200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | 9099029199 | ||||||||
| Practice Location | |||||||||
| Address1: | 954 W FOOTHILL BLVD | ||||||||
| Address2: | FOOTHILLS PSYCHOLOGICAL SERVICES SUITE A | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099464222 | ||||||||
| FaxNumber: | 9099468243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY9588 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.