Healthcare Provider Details

I. General information

NPI: 1902628258
Provider Name (Legal Business Name): NEHA N KOTHARI ARDMS,RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 MOODY ST STE 209
LA PALMA CA
90623-1177
US

IV. Provider business mailing address

7002 MOODY ST STE 209
LA PALMA CA
90623-1177
US

V. Phone/Fax

Practice location:
  • Phone: 714-300-5799
  • Fax:
Mailing address:
  • Phone: 714-300-5799
  • Fax: 562-202-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number128465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: