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General NPI Number Information
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NPI Number | 1083014906
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Entity Type | Individual
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Provider Name | SANDY CORINA EQUITE-RODAS PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 4760 SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4820
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Country | US
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Telephone | 310-390-6612
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Fax | 310-398-5690
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Provider Business Mailing Address
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Address Line | 4760 SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4820
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Country | US
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Telephone | 310-390-6612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY32114
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY32114
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License Number State | CA
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