Provider Demographics
NPI:1568796423
Name:ROCHELLE C FELDMAN
Entity Type:Organization
Organization Name:ROCHELLE C FELDMAN
Other - Org Name:PRIMA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-424-9000
Mailing Address - Street 1:18520 VIA PRINCESSA
Mailing Address - Street 2:SUITE C2
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8326
Mailing Address - Country:US
Mailing Address - Phone:661-424-9000
Mailing Address - Fax:661-424-0808
Practice Address - Street 1:18520 VIA PRINCESSA
Practice Address - Street 2:SUITE C2
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8326
Practice Address - Country:US
Practice Address - Phone:661-424-9000
Practice Address - Fax:661-424-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G324081Medicaid