Provider Demographics
NPI:1942310222
Name:RODGERS, PATRICE B (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:B
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4841
Mailing Address - Country:US
Mailing Address - Phone:310-316-0980
Mailing Address - Fax:
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-539-6040
Practice Address - Fax:310-539-7307
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496540363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health