Provider Demographics
NPI:1871858084
Name:JOSEPH H. RODD M.D. INC
Entity type:Organization
Organization Name:JOSEPH H. RODD M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:RODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-329-2170
Mailing Address - Street 1:20710 S. LEAPWOOD AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:310-329-2170
Mailing Address - Fax:310-329-9026
Practice Address - Street 1:20710 S. LEAPWOOD AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-329-2170
Practice Address - Fax:310-329-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA401302084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40130OtherMEDICARE PROVIDER PTAN #