Provider Demographics
NPI:1467917732
Name:RODRIGUEZ NUNO, JOSE RAMON DE JESUS
Entity type:Individual
Prefix:
First Name:JOSE RAMON DE JESUS
Middle Name:
Last Name:RODRIGUEZ NUNO
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 1:17284 NEWHOPE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-8201
Mailing Address - Country:US
Mailing Address - Phone:833-922-2669
Mailing Address - Fax:714-509-1545
Practice Address - Street 1:4221 N PIONEER DR BLDG 3
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5629
Practice Address - Country:US
Practice Address - Phone:480-847-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-24-76751103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst