Provider Demographics
NPI:1215144175
Name:RESENDEZ, JOSE A JR (MS , ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:RESENDEZ
Suffix:JR
Gender:M
Credentials:MS , ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 LAKE KATIE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7699
Mailing Address - Country:US
Mailing Address - Phone:310-709-9051
Mailing Address - Fax:
Practice Address - Street 1:500 DAVID J STERN WALK
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3346
Practice Address - Country:US
Practice Address - Phone:310-709-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30232255A2300X
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
020402143OtherNATA