Healthcare Provider Details

I. General information

NPI: 1184130205
Provider Name (Legal Business Name): RODNEY COLLINS, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8484 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-3235
US

IV. Provider business mailing address

1801 CENTURY PARK E STE 2240
LOS ANGELES CA
90067-2324
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-7690
  • Fax: 323-544-1125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAM DEKIN
Title or Position: CEO
Credential:
Phone: 760-641-3972