Provider Demographics
NPI:1124244520
Name:JESPERSEN, RHONDA M (MA)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:M
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81833 DOCTOR CARREON BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5590
Mailing Address - Country:US
Mailing Address - Phone:760-775-1113
Mailing Address - Fax:760-775-3222
Practice Address - Street 1:81833 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5590
Practice Address - Country:US
Practice Address - Phone:760-775-1113
Practice Address - Fax:760-775-3222
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1216237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0012160Medicaid
CAHA0026630Medicaid
CA4309846OtherAETNA
CAAO554ZMedicare PIN