Provider Demographics
NPI:1164171856
Name:RODELO, CARINA S (PA-C)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:S
Last Name:RODELO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-851-2462
Mailing Address - Fax:
Practice Address - Street 1:168 N BRENT ST STE 502
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-641-2000
Practice Address - Fax:805-653-1644
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant