Provider Demographics
NPI:1447564133
Name:CAPO-RODRIGUEZ, JORGE A (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:CAPO-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55497 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:THERMAL
Mailing Address - State:CA
Mailing Address - Zip Code:92274-9412
Mailing Address - Country:US
Mailing Address - Phone:760-600-0601
Mailing Address - Fax:
Practice Address - Street 1:55497 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:THERMAL
Practice Address - State:CA
Practice Address - Zip Code:92274-9412
Practice Address - Country:US
Practice Address - Phone:760-399-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252942207Q00000X, 208D00000X
CAC150053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice