Provider Demographics
NPI:1477553261
Name:RODA, ALISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:A
Last Name:RODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:A
Other - Last Name:LADRINGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10305 PROMENADE PKWY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-9400
Mailing Address - Country:US
Mailing Address - Phone:916-478-5000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:12140 NEW YORK RANCH RD
Practice Address - Street 2:JACKSON RANCHERIA HEALTH COMPLEX
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9407
Practice Address - Country:US
Practice Address - Phone:209-257-2400
Practice Address - Fax:209-257-2403
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791640Medicaid
CA00G791640Medicaid