Healthcare Provider Details

I. General information

NPI: 1194601815
Provider Name (Legal Business Name): RACHEL BRODSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR
BEVERLY HILLS CA
90210-4231
US

IV. Provider business mailing address

2808 ANGELO DR
LOS ANGELES CA
90077-2104
US

V. Phone/Fax

Practice location:
  • Phone: 310-997-4884
  • Fax:
Mailing address:
  • Phone: 818-231-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA66901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberPA66901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: