Basic Information
| Provider Information | |||||||||
| NPI: | 1598113789 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RODNEY L. COBB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 W ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902203500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106322113 | ||||||||
| FaxNumber: | 3106320047 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 W ALONDRA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902203500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106322113 | ||||||||
| FaxNumber: | 3106320047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2016 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | COBB | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | LAMONT | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3106322113 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 38978 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
ID Information
| ID | Type | State | Issuer | Description | 1457548810 | 05 | CA | MEDICAID | 1588732218 | 05 | CA | MEDICAID | 1912281700 | 05 | CA | MEDICAID |