Provider Demographics
NPI:1053368167
Name:FELDMAN, ROCHELLE C (MD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:C
Last Name:FELDMAN
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 1:1613 S BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3005
Mailing Address - Country:US
Mailing Address - Phone:310-842-4806
Mailing Address - Fax:
Practice Address - Street 1:18520 VIA PRINCESSA
Practice Address - Street 2:C-2
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8326
Practice Address - Country:US
Practice Address - Phone:661-424-0900
Practice Address - Fax:661-424-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G324081Medicaid
CAA45141Medicare UPIN