Provider Demographics
NPI:1255338406
Name:LUSTER, RHONDA ROCHEE (MD)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:ROCHEE
Last Name:LUSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:626-639-3005
Practice Address - Street 1:1900 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5502
Practice Address - Country:US
Practice Address - Phone:562-591-8676
Practice Address - Fax:877-469-3631
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01363676OtherRAILROAD MEDICARE-DS9933
CAP01363693OtherRAILROAD MEDICARE-DU4034
CAP01363660OtherRAILROAD MEDICARE-DU4032
CA00G769100OtherMEDI CAL
CAP01453387-DV5277OtherRAILROAD MEDICARE
CAP01363693OtherRAILROAD MEDICARE-DU4034
CAF90582Medicare UPIN
CACA141451Medicare PIN
CAP01453387-DV5277OtherRAILROAD MEDICARE
CACA118009-GA222AMedicare PIN
CAP01363676OtherRAILROAD MEDICARE-DS9933
CACB207437-GB232BMedicare PIN