Healthcare Provider Details

I. General information

NPI: 1821186958
Provider Name (Legal Business Name): AUGUSTO ROJAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11961 VENICE BLVD
LOS ANGELES CA
90066-3905
US

IV. Provider business mailing address

11961 VENICE BLVD
LOS ANGELES CA
90066-3905
US

V. Phone/Fax

Practice location:
  • Phone: 310-391-7143
  • Fax:
Mailing address:
  • Phone: 310-391-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA-41262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: