Provider Demographics
NPI:1194497255
Name:RHODES, DAIMON
Entity type:Individual
Prefix:MR
First Name:DAIMON
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 QUAIL LAKES DR APT 29
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-9109
Mailing Address - Country:US
Mailing Address - Phone:925-752-4250
Mailing Address - Fax:
Practice Address - Street 1:1919 QUAIL LAKES DR APT 29
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-9109
Practice Address - Country:US
Practice Address - Phone:925-752-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist