Healthcare Provider Details

I. General information

NPI: 1073587358
Provider Name (Legal Business Name): JOHN RODARTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 FOOTHILL BLVD SUITE 201
LA CANADA CA
91011-2122
US

IV. Provider business mailing address

1346 FOOTHILL BLVD STE 201
LA CANADA CA
91011-2143
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-5583
  • Fax: 818-790-1377
Mailing address:
  • Phone: 818-790-5583
  • Fax: 818-790-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA055748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: