Dr Alisa A Roda, MD | |
12140 New York Ranch Rd, Jackson Rancheria Health Complex, Jackson, CA 95642-9407 | |
(209) 257-2400 | |
(209) 257-2403 |
Full Name | Dr Alisa A Roda |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 12140 New York Ranch Rd, Jackson, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477553261 | NPI | - | NPPES |
00G791640 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | G79164 (California) | Primary |
Entity Name | Permanente Medical Group Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
Mailing Address | Practice Location Address |
---|---|
Dr Alisa A Roda, MD 10305 Promenade Pkwy, Elk Grove, CA 95757-9400 Ph: (916) 478-5000 | Dr Alisa A Roda, MD 12140 New York Ranch Rd, Jackson Rancheria Health Complex, Jackson, CA 95642-9407 Ph: (209) 257-2400 |
Dr. Amy A. Appleton, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 100 Mission Blvd, Suite 2600, Jackson, CA 95642 Phone: 209-257-1722 | |
Jayasree Vasudevan Nair, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Mission Blvd Ste 2600, Jackson, CA 95642 Phone: 209-257-1722 Fax: 209-257-1726 | |
Dr. Vikram Ramkumar Kumar, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 100 Mission Blvd, Suite 2600, Jackson, CA 95642 Phone: 209-257-1722 Fax: 209-257-1726 | |
Dr. David J Stone, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Mission Blvd, Suite 2600, Jackson, CA 95642 Phone: 209-257-1722 Fax: 209-257-1726 |