Provider Demographics
NPI:1598973828
Name:RENDON, CARLOS O (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:O
Last Name:RENDON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2660
Mailing Address - Country:US
Mailing Address - Phone:323-231-7700
Mailing Address - Fax:323-231-0799
Practice Address - Street 1:4301 S FIGUEROA ST
Practice Address - Street 2:# F
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2660
Practice Address - Country:US
Practice Address - Phone:323-231-7700
Practice Address - Fax:323-231-0799
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant