Provider Demographics
NPI:1417038787
Name:PINA, RODRIGO EDUARDO (DC)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:EDUARDO
Last Name:PINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2207
Mailing Address - Country:US
Mailing Address - Phone:310-792-5490
Mailing Address - Fax:310-792-5495
Practice Address - Street 1:4515 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2207
Practice Address - Country:US
Practice Address - Phone:310-792-5490
Practice Address - Fax:310-792-5495
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC29192AMedicare ID - Type UnspecifiedMEDICARE NUMBER