Healthcare Provider Details

I. General information

NPI: 1164886792
Provider Name (Legal Business Name): RHANIKA ALEXANDRA DEMA-ALA NEUDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RHANIKA ALEXANDRA GEPIELAGO DEMA-ALA MD

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 102
LOS ANGELES CA
90049-5012
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD STE 102
LOS ANGELES CA
90049-5012
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-7777
  • Fax: 310-445-8709
Mailing address:
  • Phone: 310-208-7777
  • Fax: 310-445-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA167352
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA167352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: