Healthcare Provider Details

I. General information

NPI: 1659394633
Provider Name (Legal Business Name): DANIEL RADNIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S ROBERTSON BLVD 101
LOS ANGELES CA
90035-1505
US

IV. Provider business mailing address

12409 TEXAS AVE APT 09
LOS ANGELES CA
90025-1970
US

V. Phone/Fax

Practice location:
  • Phone: 310-985-4124
  • Fax: 310-652-9292
Mailing address:
  • Phone: 310-985-4124
  • Fax: 310-652-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number92103
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA92103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: