Healthcare Provider Details

I. General information

NPI: 1326314766
Provider Name (Legal Business Name): NATHANIEL DAUM GINDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ C8-193
LOS ANGELES CA
90024
US

IV. Provider business mailing address

760 WESTWOOD PLZ C8-193
LOS ANGELES CA
90024-5055
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-7284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA130251
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA130251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: