Provider Demographics
NPI:1366121576
Name:RASMUSSEN, JESSE (CPO)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15602 MOSHER AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6427
Mailing Address - Country:US
Mailing Address - Phone:949-474-2050
Mailing Address - Fax:949-474-4460
Practice Address - Street 1:1530 S SINCLAIR ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5933
Practice Address - Country:US
Practice Address - Phone:949-474-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist