Healthcare Provider Details

I. General information

NPI: 1861130965
Provider Name (Legal Business Name): ROD PAULSEN MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

760 WESTWOOD PLZ
LOS ANGELES CA
90024-5055
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0548
  • Fax: 310-825-0340
Mailing address:
  • Phone: 310-825-0548
  • Fax: 310-825-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA191466
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA191466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: