Healthcare Provider Details

I. General information

NPI: 1710396171
Provider Name (Legal Business Name): LETICIA RODAS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2014
Last Update Date: 08/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 SEPULVEDA BLVD
CULVER CITY CA
90230-6406
US

IV. Provider business mailing address

6119 S FAIRFAX AVE
LOS ANGELES CA
90056-1834
US

V. Phone/Fax

Practice location:
  • Phone: 310-397-2229
  • Fax:
Mailing address:
  • Phone: 323-855-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number1580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: