Provider Demographics
NPI:1679984348
Name:RINCON, JOHN ANDREW JR (AOD COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:RINCON
Suffix:JR
Gender:M
Credentials:AOD COUNSELOR
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:RINCON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:AOD COUNSELOR
Mailing Address - Street 1:23950 PRADO LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9734
Mailing Address - Country:US
Mailing Address - Phone:909-514-1958
Mailing Address - Fax:
Practice Address - Street 1:3430 COGSWELL RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2785
Practice Address - Country:US
Practice Address - Phone:626-453-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA10436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)