Healthcare Provider Details

I. General information

NPI: 1871404046
Provider Name (Legal Business Name): MEDPODLA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 911
BEVERLY HILLS CA
90210-4212
US

IV. Provider business mailing address

465 N ROXBURY DR STE 911
BEVERLY HILLS CA
90210-4212
US

V. Phone/Fax

Practice location:
  • Phone: 424-279-6337
  • Fax:
Mailing address:
  • Phone: 424-279-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GHIYAM
Title or Position: LEAD PHYSICIAN
Credential: MD
Phone: 424-279-6337