Provider Demographics
NPI:1689495616
Name:RODAS, KELLY
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:RODAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:DENISSE
Other - Last Name:RODAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23411 SUMMERFIELD APT 35A
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2861
Mailing Address - Country:US
Mailing Address - Phone:323-894-8229
Mailing Address - Fax:
Practice Address - Street 1:23411 SUMMERFIELD APT 35A
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2861
Practice Address - Country:US
Practice Address - Phone:323-894-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula