Healthcare Provider Details

I. General information

NPI: 1093757957
Provider Name (Legal Business Name): JAMES M LODDENGAARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 TORRANCE BLVD STE 210
TORRANCE CA
90503-4009
US

IV. Provider business mailing address

5215 TORRANCE BLVD STE 210
TORRANCE CA
90503-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-6190
  • Fax: 310-540-7362
Mailing address:
  • Phone: 310-316-6190
  • Fax: 310-540-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG40119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: