Healthcare Provider Details

I. General information

NPI: 1346505294
Provider Name (Legal Business Name): NEELAM PATHIKONDA D.O. MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W MANCHESTER AVE
LOS ANGELES CA
90047-5424
US

IV. Provider business mailing address

1550 W MANCHESTER AVE
LOS ANGELES CA
90047-5424
US

V. Phone/Fax

Practice location:
  • Phone: 800-954-8000
  • Fax:
Mailing address:
  • Phone: 800-954-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: