Provider Demographics
NPI:1821215914
Name:ANA LASTENIA RODAS
Entity Type:Organization
Organization Name:ANA LASTENIA RODAS
Other - Org Name:CLINICA MEDICA CUZCATLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LASTENIA
Authorized Official - Last Name:RODAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-581-8485
Mailing Address - Street 1:3559 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1042
Mailing Address - Country:US
Mailing Address - Phone:323-581-8485
Mailing Address - Fax:323-923-2809
Practice Address - Street 1:3559 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1042
Practice Address - Country:US
Practice Address - Phone:323-581-8485
Practice Address - Fax:323-923-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40282208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40282OtherLINCENSE
CAGR0092880OtherPROVIDER NUMBER MEDICAL
CA00A402820Medicaid
CAGR0092880OtherPROVIDER NUMBER MEDICAL
CAF42596Medicare UPIN