Healthcare Provider Details

I. General information

NPI: 1831717768
Provider Name (Legal Business Name): ALEXANDER GHATAN, DO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16952 VENTURA BLVD
ENCINO CA
91316-4197
US

IV. Provider business mailing address

1255 FEDERAL AVE APT 104
LOS ANGELES CA
90025-3969
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-3964
  • Fax: 818-789-3967
Mailing address:
  • Phone: 818-613-0551
  • Fax: 818-789-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER GHATAN
Title or Position: PRESIDENT
Credential: DO
Phone: 818-613-0551