Provider Demographics
NPI:1114149150
Name:RODRIGUEZ, SYLVIA (PA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 E OLYMPIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-3347
Mailing Address - Country:US
Mailing Address - Phone:323-262-9948
Mailing Address - Fax:323-262-3708
Practice Address - Street 1:4146 E OLYMPIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3347
Practice Address - Country:US
Practice Address - Phone:323-262-9948
Practice Address - Fax:323-262-3708
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17699Medicaid
CAQ33951Medicare UPIN
CAPA17699Medicaid