Healthcare Provider Details

I. General information

NPI: 1770887788
Provider Name (Legal Business Name): RODINA VATANPARAST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD STE 260
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 424-212-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA128081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: