Healthcare Provider Details

I. General information

NPI: 1053368167
Provider Name (Legal Business Name): ROCHELLE C FELDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18520 VIA PRINCESSA C-2
CANYON COUNTRY CA
91387-8326
US

IV. Provider business mailing address

1613 S BEVERLY DR
LOS ANGELES CA
90035-3005
US

V. Phone/Fax

Practice location:
  • Phone: 661-424-0900
  • Fax: 661-424-0924
Mailing address:
  • Phone: 310-842-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG32408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: