Healthcare Provider Details

I. General information

NPI: 1487232203
Provider Name (Legal Business Name): GIANCARLO CARDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-1732
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400 STE 400
LOS ANGELES CA
90095-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-0944
  • Fax:
Mailing address:
  • Phone: 310-267-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA200937
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberA200937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: