Provider Demographics
NPI:1447254974
Name:RODNEY BLUESTONE MEDICAL CORPORATION
Entity type:Organization
Organization Name:RODNEY BLUESTONE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-657-2222
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:STE 303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4320
Mailing Address - Country:US
Mailing Address - Phone:310-657-2222
Mailing Address - Fax:310-550-0367
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:STE 303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4320
Practice Address - Country:US
Practice Address - Phone:310-657-2222
Practice Address - Fax:310-550-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6025Medicare PIN