Provider Demographics
NPI:1073587358
Name:RODARTE, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RODARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1346 FOOTHILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2143
Mailing Address - Country:US
Mailing Address - Phone:818-790-5583
Mailing Address - Fax:818-790-9517
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-5583
Practice Address - Fax:818-790-1377
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA055748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72722Medicare UPIN