Healthcare Provider Details

I. General information

NPI: 1457449498
Provider Name (Legal Business Name): AUGUSTO ROJAS M.D, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/30/2009
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 TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License NumberA41262
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA41262
License Number StateCA

VIII. Authorized Official

Name: AUGUSTO ROJAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-391-7143