Provider Demographics
NPI:1245193259
Name:RODRIGUEZ, JOSE JESUS (PPSC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JESUS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4587 APTOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-2604
Mailing Address - Country:US
Mailing Address - Phone:408-509-7893
Mailing Address - Fax:
Practice Address - Street 1:5035 EDENVIEW DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4031
Practice Address - Country:US
Practice Address - Phone:408-227-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210156252101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty