Provider Demographics
NPI:1841918026
Name:RHONDA LUSTER MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RHONDA LUSTER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-721-0362
Mailing Address - Street 1:PO BOX 32854
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0606
Mailing Address - Country:US
Mailing Address - Phone:904-643-4353
Mailing Address - Fax:904-643-4353
Practice Address - Street 1:8540 S SEPULVEDA BLVD STE 820
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3808
Practice Address - Country:US
Practice Address - Phone:904-643-4353
Practice Address - Fax:904-643-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty