Healthcare Provider Details

I. General information

NPI: 1578891867
Provider Name (Legal Business Name): DR. RODNEY BARRON MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N VERMONT AVE SUITE 205
LOS ANGELES CA
90029-1748
US

IV. Provider business mailing address

1211 N VERMONT AVE SUITE 205
LOS ANGELES CA
90029-1748
US

V. Phone/Fax

Practice location:
  • Phone: 323-664-4114
  • Fax: 323-664-4044
Mailing address:
  • Phone: 323-664-4114
  • Fax: 323-664-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY STEPHEN BARRON
Title or Position: DIRECTOR
Credential: M.D.
Phone: 323-664-4114