Provider Demographics
NPI:1447307749
Name:ANTHONY G. RODAS, MD INC
Entity type:Organization
Organization Name:ANTHONY G. RODAS, MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-321-7222
Mailing Address - Street 1:17525 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3843
Mailing Address - Country:US
Mailing Address - Phone:818-995-8590
Mailing Address - Fax:818-285-5955
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2462
Practice Address - Country:US
Practice Address - Phone:310-321-7222
Practice Address - Fax:310-321-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89704Medicare UPIN
CAW11663Medicare ID - Type UnspecifiedGROUP