Healthcare Provider Details

I. General information

NPI: 1427323575
Provider Name (Legal Business Name): RUCHA GADGIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST IPT 4TH FLOOR - SUITE C4J100
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

5152 RUSSO ST
CULVER CITY CA
90230-5949
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA163152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA163152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: