Healthcare Provider Details

I. General information

NPI: 1285771360
Provider Name (Legal Business Name): PAUL RODRICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD #1280
ENCINO CA
91436-2124
US

IV. Provider business mailing address

PO BOX 2934 & ONE HALF BEVERLY GLEN CIRCLE #308
BEL AIR CA
90077
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-2164
  • Fax: 818-782-5330
Mailing address:
  • Phone: 760-772-8357
  • Fax: 760-772-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG84064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: