Basic Information
| Provider Information | |||||||||
| NPI: | 1164745329 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JDT CONSULTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1180 THERESA ST | ||||||||
| Address2: | |||||||||
| City: | SEASIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939555729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592211680 | ||||||||
| FaxNumber: | 5592214336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 THERESA ST | ||||||||
| Address2: | |||||||||
| City: | SEASIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939555729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592211680 | ||||||||
| FaxNumber: | 5592214336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2010 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | NYDIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5592211680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, ASW | ||||||||
| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.