MEDICARE: KARLA YANINA RODAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	106H00000X	Marriage & Family Therapist	119696	CA

General Provider Information

NPI Number	:	1659982429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA YANINA RODAS

Provider Business Mailing Address
First Line	:	PO BOX 3533
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-8593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 170
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3818
Country	:	US
Telephone Number	:	213-290-5483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/01/2023

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Directions to “ KARLA YANINA RODAS ” Practice Location

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