Healthcare Provider Details

I. General information

NPI: 1306895990
Provider Name (Legal Business Name): DAVID F BODE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S SUNSET AVE STE 100
WEST COVINA CA
91790-3937
US

IV. Provider business mailing address

777 FLOWER ST STE A
GLENDALE CA
91201-3000
US

V. Phone/Fax

Practice location:
  • Phone: 626-856-2215
  • Fax: 626-960-2125
Mailing address:
  • Phone: 818-637-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberC30670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: