Provider Demographics
NPI:1154972099
Name:VELA RODRIGUEZ, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:VELA RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 BARRY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8701
Mailing Address - Country:US
Mailing Address - Phone:310-819-6858
Mailing Address - Fax:
Practice Address - Street 1:1724 BARRY AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8701
Practice Address - Country:US
Practice Address - Phone:310-819-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93510612AMedicaid