Provider Demographics
NPI:1427343912
Name:RHODES, JESSICA (MD, MPH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:MD, MPH
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Other - Credentials:
Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7620
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-541-7900
Practice Address - Fax:707-573-5411
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA144933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA144933OtherSTATE MEDICAL LICENSE
CAFR6347656OtherFEDERAL DEA LICENSE