Provider Demographics
NPI:1932158540
Name:ROLANDHEIGHTS CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:ROLANDHEIGHTS CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-383-7030
Mailing Address - Street 1:2681 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2883
Mailing Address - Country:US
Mailing Address - Phone:213-383-7030
Mailing Address - Fax:
Practice Address - Street 1:2681 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 2201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2883
Practice Address - Country:US
Practice Address - Phone:213-383-7030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15700Medicare ID - Type Unspecified