Healthcare Provider Details

I. General information

NPI: 1912580762
Provider Name (Legal Business Name): ELI AHDOOT, DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 370
BURBANK CA
91505-4562
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 370
BURBANK CA
91505-4562
US

V. Phone/Fax

Practice location:
  • Phone: 818-324-5577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELI AHDOOT
Title or Position: PRESIDENT
Credential: DO
Phone: 818-322-0126