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General NPI Number Information
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NPI Number | 1164979803
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Entity Type | Organization
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Legal Business Name | NEIL GHODADRA M.D. INC
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 10780 SANTA MONICA BLVD SUITE 210
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City | LOS ANGELES
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State | CA
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Zip | 90025-4749
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Country | US
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Telephone | 310-929-4787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8636
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City | CALABASAS
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State | CA
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Zip | 91372-8636
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Country | US
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Telephone | 678-596-1344
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/DIRECTOR
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Name | DR. NEIL S. GHODADRA
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Credential | MD
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Telephone | 678-596-1344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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