Provider Demographics
NPI:1427048768
Name:RODAS, ANA LASTENIA (MD)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LASTENIA
Last Name:RODAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1042
Mailing Address - Country:US
Mailing Address - Phone:323-581-8485
Mailing Address - Fax:323-923-2809
Practice Address - Street 1:3559 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1042
Practice Address - Country:US
Practice Address - Phone:323-581-8485
Practice Address - Fax:323-923-2809
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40282208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40282OtherLICENSE
CAGR0092880OtherMEDICAL PROVIDER NUMBER
CA00A402820Medicaid
F42596Medicare UPIN
CAA40282Medicare PIN