Healthcare Provider Details

I. General information

NPI: 1265816680
Provider Name (Legal Business Name): ALEXANDER GHATAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 305
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR STE 305
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 855-786-7846
  • Fax: 818-471-4699
Mailing address:
  • Phone: 855-786-7846
  • Fax: 888-885-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A15278
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A15278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: