Healthcare Provider Details

I. General information

NPI: 1821215914
Provider Name (Legal Business Name): ANA LASTENIA RODAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 E GAGE AVE
BELL CA
90201-1042
US

IV. Provider business mailing address

3559 E GAGE AVE
BELL CA
90201-1042
US

V. Phone/Fax

Practice location:
  • Phone: 323-581-8485
  • Fax: 323-923-2809
Mailing address:
  • Phone: 323-581-8485
  • Fax: 323-923-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA40282
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40282
License Number StateCA

VIII. Authorized Official

Name: MRS. ANA LASTENIA RODAS
Title or Position: PEDIATRICS
Credential: MD
Phone: 323-581-8485