Provider Demographics
NPI:1407642796
Name:RODAS, INDIANA ELIZABETH
Entity type:Individual
Prefix:
First Name:INDIANA
Middle Name:ELIZABETH
Last Name:RODAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 FERN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1560
Mailing Address - Country:US
Mailing Address - Phone:619-459-2080
Mailing Address - Fax:
Practice Address - Street 1:2594 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1560
Practice Address - Country:US
Practice Address - Phone:619-459-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA6761074OtherDRIVER LICENSE