Provider Demographics
NPI:1174906614
Name:ARTILES, RODNEY ALEXANDER (LAC)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:ALEXANDER
Last Name:ARTILES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2116
Mailing Address - Country:US
Mailing Address - Phone:510-501-0564
Mailing Address - Fax:
Practice Address - Street 1:2706 PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1523
Practice Address - Country:US
Practice Address - Phone:510-501-0564
Practice Address - Fax:510-903-4252
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist