Provider Demographics
NPI:1265428189
Name:RODAS, ANTONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:G
Last Name:RODAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ROSECRANS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2462
Mailing Address - Country:US
Mailing Address - Phone:310-321-7222
Mailing Address - Fax:310-721-7227
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2462
Practice Address - Country:US
Practice Address - Phone:310-321-7222
Practice Address - Fax:310-721-7227
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAG40366207R00000X, 207RP1001X, 2083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11663Medicare ID - Type Unspecified
CAA89704Medicare UPIN