JESUS PRIMITIVO RENDON NPI 1467970616

NPI Information

NPI: 1467970616
Provider Name: JESUS PRIMITIVO RENDON
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: PINNACLE PAIN CENTER, PS

PECOS Registration: Yes

Address:
12709 E MIRABEAU PKWY
BLDG A STE 200
SPOKANE VALLEY, WA
ZIP 99216
Phone: (509) 591-0070
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Jesus Primitivo Rendon is a medical physician assistant in Spokane Valley, WA with 6 years of experience. Jesus Primitivo Rendon NPI is 1467970616. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduation Year:2018

The provider's business location address is:

12709 E MIRABEAU PKWY
BLDG A STE 200
SPOKANE VALLEY, WA
ZIP 99216
Phone: (509) 591-0070
Fax: (509) 591-0070

The NPI 1467970616 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/7/2017 and was last updated on 10/9/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA60932463	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	OA60965163	OTHER	WASHINGTON	STATE LICENSE
2	PA60932463	OTHER	WASHINGTON	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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