Provider Demographics
NPI:1386824993
Name:RODD, NINA T (PHD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:T
Last Name:RODD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:609 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3629
Mailing Address - Country:US
Mailing Address - Phone:310-378-7172
Mailing Address - Fax:310-541-9308
Practice Address - Street 1:609 DEEP VALLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3629
Practice Address - Country:US
Practice Address - Phone:310-378-7172
Practice Address - Fax:310-541-9308
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16624103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist