Healthcare Provider Details

I. General information

NPI: 1851386155
Provider Name (Legal Business Name): KATHRYN P RODAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/13/2006

III. Provider practice location address

3300 WEBSTER ST
OAKLAND CA
94609-3117
US

IV. Provider business mailing address

3300 WEBSTER ST
OAKLAND CA
94609-3125
US

V. Phone/Fax

Practice location:
  • Phone: 510-763-2662
  • Fax: 510-763-2679
Mailing address:
  • Phone: 510-763-2662
  • Fax: 510-763-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG53393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: