Healthcare Provider Details

I. General information

NPI: 1093223034
Provider Name (Legal Business Name): ANATOL PODOLSKY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18035 BROOKHURST ST STE 1200
FOUNTAIN VALLEY CA
92708-6738
US

IV. Provider business mailing address

400 NEWPORT CENTER DR STE 601
NEWPORT BEACH CA
92660-7685
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-6882
  • Fax: 949-644-2377
Mailing address:
  • Phone: 949-644-6882
  • Fax: 949-644-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANATOL PODOLSKY
Title or Position: CEO / OWNER
Credential: MD
Phone: 949-644-6882